2030 Claims Processing Jobs - Page 40

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

Experience 3 to 15 years Skills Guidewire Developer experience with any of the detailed skill like (Policy / Billing / Claims / Integration / Configuration / Insurance Now / Portal / Rating) Insurance domain knowledge with Property & Casualty background Hands on experience in at least one of the Guidewire products (Claim/Policy/Billing) Should have knowledge on Admin data loading. Good knowledge in Web services, XML, GxModel, Messaging, Batch implementation, Integrating with 3rd Party Systems and Document composition tools like Xpressions, Thunderhead Experience on any database Oracle / SQL Server and well versed in SQL Designed & modified existing workflows (required for Billing Integration) Experience in SCRUM Agile, prefer Certified Scrum Master (CSM) Good written and oral communication Excellent analytical skills. Works in the area of Software Engineering, which encompasses the development, maintenance and optimization of software solutions/applications.1. Applies scientific methods to analyse and solve software engineering problems.2. He/she is responsible for the development and application of software engineering practice and knowledge, in research, design, development and maintenance.3. His/her work requires the exercise of original thought and judgement and the ability to supervise the technical and administrative work of other software engineers.4. The software engineer builds skills and expertise of his/her software engineering discipline to reach standard software engineer skills expectations for the applicable role, as defined in Professional Communities.5. The software engineer collaborates and acts as team player with other software engineers and stakeholders. Job Description - Grade Specific Is fully competent in it's own area and has a deep understanding of related programming concepts software design and software development principles. Works autonomously with minimal supervision. Able to act as a key contributor in a complex environment, lead the activities of a team for software design and software development. Acts proactively to understand internal/external client needs and offers advice even when not asked. Able to assess and adapt to project issues, formulate innovative solutions, work under pressure and drive team to succeed against its technical and commercial goals. Aware of profitability needs and may manage costs for specific project/work area. Explains difficult concepts to a variety of audiences to ensure meaning is understood. Motivates other team members and creates informal networks with key contacts outside own area.

Looking for an Accounting Receivable Specialist with 1+ year of U.S. medical billing experience, knowledge of EOBs, denials, CPT codes, and U.S. insurance. Must work U.S. shifts from Pune. Healthcare experience required. Provident fund

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims needs to be completed adhering to required TAT and quality SLA. Key Results Production, Quality Shift and Schedule adherence Process Knowledge Minimum Eligibility: Candidates should have minimum 1 year Experience in Claims Adjudication & Claims Adjustment or Claims Adjudication with Appeals & Grievances Shift Details: Night shift / Flexible to work in any shift and timingCab Boundary Limit: Up to 30 km (One way drop cab) Job Location: Firstsource Solution Limited,5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103.Landmark near Vivira Mall. Contact: Arun HR Phone: 6374232238 Email: arun.kumar9@firstsource.com If you are interested please share your updated CV to the arun.kumar9@firstsource.com or 6374232238 Join us to be part of a dynamic team with career growth opportunities. We look forward to seeing you at the interview! You can refer your friends as well! Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or arun.kumar9@firstsource.com

Role & responsibilities To be able to process P & A claims as a Claims Manager Preferred candidate profile Any Graduate with experience of minimum 1year with P&A Claims experience in Health

Job Title: Senior CSA Job Category: Associate Function/Department: Operations Role Description: Roles & Responsibilities Processing and data entry for routine types of physician and contract linkage transactions such as: Load new physician demographics and contract linkage using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Perform physician demographics and contract linkage data using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Responsible for ensuring all data elements necessary to complete the request are provided and responds to the submitter with a detailed outline if additional information is needed Use desk-top macros whenever possible to ensure data loading accuracy and efficiency Send large requests capable of being automated as defined by management to the AST Provide excellent customer service to customers (physician, health plans, affiliates, delegates, insured, and all associated business partners) by: Quickly and accurately identifying and assessing customer needs and taking appropriate action steps to satisfy those needs Solve problems systematically using sound business judgment and following through on commitments using an automated approach whenever possible Respond to customers in a polite and professional manner Complete assigned work within established TAT and Quality metrics while remaining within downtime parameters to ensure customer satisfaction Key Results Production, Quality Shift and Schedule adherence Process Knowledge Role Holder Profile A. Preferred educational qualifications: Graduation (Any discipline - 3 years) without arrears. B. Preferred work experience: Minimum 6 months to 1 year of experience in Provided Data Management C. Skills and Competencies Mandatory knowledge in health care industry and PDM Working knowledge of systems platforms preferred PC skills (Power Point, Word, Excel, Access, Lotus Notes, Intranet) preferred Strong customer service orientation required i. Functional / Technical: ii. Behavioral: Shift Adherence Floor Decorum Interpersonal skills Team Player

Create the future of e-health together with us by becoming a Manager Credentialing. As one of the Best in KLAS RCM organization in the industry we offer a full scope of RCM services as well as BPO services, our organization gives our team members the training and solutions to learn and grow across variety of technologies and processes. As an innovator and leader in the e-health services we offer unparalleled growth opportunities in the industry. What you can expect from us: A safe digital application and a structured and streamlined onboarding process. An extensive group health and accidental insurance program. Our progressive transportation model allows you to choose: You can either receive a self-transport allowance, or we can pick you up and drop you off on your way from or to the office. Subsidized meal facility. Fun at Work. Various career growth opportunities as well as a lucrative merit increment policy in a work environment where we promote Diversity, Equity, and Inclusion. Best HR practices along with an open-door policy to ensure a very employee friendly environment. A recession proof and secured workplace for our entire workforce. Ample scope of reward and recognitions along with perks. What you can do for us: Compiles and maintains current and accurate data for all providers. Completes provider enrollment credentialing and re-credentialing applications; monitors applications and follows-up as needed. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Build knowledge base for payer requirements and forms for multiple states Track license and certification expirations for all providers to ensure timely renewals. Prepare meeting agendas and minutes for client calls. Train credentialing specialist (if applicable). Audit work completed by other departments (delegation/CAQH/Data Entry/Group & provider set up). Provide monthly invoicing data. Generate and send sign pages/application to client. Report to management any detected problems, errors, and/or changes in provider enrollment requirements upon discovery. Your Qualifications: Education: Bachelor's degree preferred. Minimum 5 years of relevant experience in Credentialing in US Healthcare (RCM. Understanding and knowledge of the credentialing and provider enrollment process. Must be able to organize and prioritize work and manage multiple priorities. Excellent verbal and written communication skills including, letters, memos and emails. Excellent attention to detail. Ability for research and analyze data. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Convinced? Submit your persuasive application now (including desired salary and earliest possible starting date).

Career Club Consultancy and Management Services is looking for Customer Service Representative- Only For Nashik Candidates Freshers to join our dynamic team and embark on a rewarding career journeyResponsible for handling customer inquiries and complaints, providing information and resolving issues in a prompt and friendly manner. Act as the first point of contact for customers and play a critical role in building and maintaining customer loyalty. The primary duties of a CSR include answering phone calls, responding to emails and chat requests, troubleshooting problems, and processing orders or returns. Good communication, interpersonal, and problem-solving skills are essential for this role.

Job Summary: The Business Analyst will play a key role in supporting finance and management information (MI) systems for an insurance company. The individual will bridge the gap between business operations, finance, and IT, ensuring the successful implementation and optimization of finance-related systems and management reporting tools. The role involves gathering business requirements, facilitating communication between stakeholders, and analyzing data to improve decision-making processes within the insurance domain. Key Responsibilities: Requirements Gathering: Collaborate with stakeholders (finance teams, insurance operations, and IT) to gather, document, and translate business requirements into functional specifications. Process Improvement: Identify inefficiencies in finance and reporting processes, recommending and implementing improvements to streamline workflows in the current system Data Analysis: Analyze finance and MI data of the current state systems System Implementation & Support: Support the implementation, integration, and optimization of finance and reporting systems, ensuring alignment with business processes for the new system. Reporting & MI Development: Design & Develop financial reports and dashboards using MI tools, providing detailed analysis and insights into key performance indicators (KPIs) on the new system Stakeholder Communication: Act as a liaison between finance, insurance operations, and IT teams, ensuring clear communication and alignment on project goals and timelines. Documentation: Create detailed documentation including business requirements, process flows, and functional specifications. Compliance & Risk Management: Ensure that finance and MI systems adhere to regulatory and compliance standards within the insurance industry. Required Qualifications: Bachelors degree in Finance, Accounting, Business, or a related field. Proven experience as a Business Analyst in the insurance domain, with a focus on finance and MI. Strong understanding of insurance products, underwriting, claims processes, and financial reporting. Proficiency in data analysis tools (e.g., Excel, Power BI, Tableau) Experience with Agile methodologies and familiarity with project management tools (e.g., JIRA, Confluence). Excellent problem-solving skills and the ability to analyze complex data sets. Strong communication skills to work with cross-functional teams and present findings to stakeholders. Preferred Qualifications: Experience with regulatory reporting (e.g., Solvency II, IFRS 17) in the insurance industry. Knowledge of management information systems and their role in insurance operations. Familiarity with financial modeling and forecasting techniques. Key Competencies: Analytical thinking and attention to detail. Strong business acumen with the ability to understand the financial implications of insurance operations. Ability to work in a fast-paced environment and manage multiple priorities. Collaborative mindset with the ability to influence and negotiate with stakeholders.

Analyst Claims- Review and process property insurance claims, including analyzing policies, assessing damage, and determining coverage and settlements. Work with insurance adjusters, clients, and third-Frty vendors to gather necessary information and documentation for claims processing. Collation of data and information of claims for reporting purposes Investigate and evaluate claims to ensure accuracy and completeness. Prepare and present reports and recommendations to management regarding claims status, trends, and outcomes. Involvement in subrogation requests and required follow-ups. Communicate with clients and stakeholders regarding claims status and resolution. Provide support to other departments and teams as needed. What You Bring To The Role Bachelor's degree in business, finance, or related field. At least 3 years of experience in property insurance claims analysis. Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Detail-oriented with the ability to manage multiple tasks simultaneously. Proficient in Microsoft Office Suite and other relevant software programs. Knowledge of property insurance policies, procedures, and regulations. Other skills: Ability to work independently as well as be a team player. Able to take direction and ask questions. Strong organizational skills. Eye for detail. Resourcefulness. Excellent communication skills Mandatory Skills: Institutional_Finance_Buy_Side_Others. Experience1-3 Years.

Work with Us. Change the World. At AECOM, we're delivering a better world. Whether improving your commute, keeping the lights on, providing access to clean water, or transforming skylines, our work helps people and communities thrive. We are the world's trusted infrastructure consulting firm, partnering with clients to solve the world’s most complex challenges and build legacies for future generations. There has never been a better time to be at AECOM. With accelerating infrastructure investment worldwide, our services are in great demand. We invite you to bring your bold ideas and big dreams and become part of a global team of over 50,000 planners, designers, engineers, scientists, digital innovators, program and construction managers and other professionals delivering projects that create a positive and tangible impact around the world. We're one global team driven by our common purpose to deliver a better world. Join us. The staff has to perform the work of chief Contract expert and needs to monitor the EPC-Contracts Qualifications Graduate in discipline. 20+ years in railway or railway related industry, out of which minimum 10 years in Metro/MRTS. Shall have worked in atleast one metro project. Additional Information

About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, and India. Our rightshore delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies Job Title: CSA and Senior CSA Grade: H1/H2 Job Category: Associate Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) Processing and data entry for routine types of physician and contract linkage transactions such as: Load new physician demographics and contract linkage using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Perform physician demographics and contract linkage data using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Responsible for ensuring all data elements necessary to complete the request are provided and responds to the submitter with a detailed outline if additional information is needed Use desk-top macros whenever possible to ensure data loading accuracy and efficiency Send large requests capable of being automated as defined by management to the AST Provide excellent customer service to customers (physician, health plans, affiliates, delegates, insured, and all associated business partners) by: Quickly and accurately identifying and assessing customer needs and taking appropriate action steps to satisfy those needs Solve problems systematically using sound business judgment and following through on commitments using an automated approach whenever possible Respond to customers in a polite and professional manner Complete assigned work within established TAT and Quality metrics while remaining within downtime parameters to ensure customer satisfaction Key Results Production, Quality Shift and Schedule adherence Process Knowledge Role Holder Profile Preferred educational qualifications: Graduation (Any discipline - 3 years) without arrears. B. Preferred work experience: Minimum 6 months to 1 year of experience in Provided Data Management C. Skills and Competencies Mandatory knowledge in health care industry and PDM Working knowledge of systems platforms preferred PC skills (Power Point, Word, Excel, Access, Lotus Notes, Intranet) preferred Strong customer service orientation required i. Functional / Technical: ii. Behavioral: Shift Adherence Floor Decorum Interpersonal skills Team Player Interested candidates can walk-in directly and write HR Name Geethika or Ilyas on top of your resume.

Role & Responsibilities Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Outstanding follow-up with TPA. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies to pass or clear the Health Insurance claims. Qualifications Bachelor's degree. Previous experience in TPA management or Banking. Good interpersonal and communication skills. Isha Thakur 9056448144 HRD

Role & responsibilities We are hiring experienced AR Medical Billing Executives for our Gurugram location. Candidates must have hands-on experience in Revenue Cycle Management (RCM), Denial Management, AR Follow-up, and AR Billing . Key Responsibilities: End-to-end AR follow-up on insurance claims Handle denials and resolve issues in a timely manner Ensure compliance with all billing policies and procedures Work collaboratively with team members to meet performance goals Requirements: Minimum 1 year of relevant experience in US medical billing Strong knowledge of RCM, denial management, and AR processes Graduation is mandatory Excellent communication skills Should be open to working in night shifts Immediate joiners preferred Perks and Benefits: Competitive salary Growth opportunities within the organization Employee-friendly work environment Interested candidates can share their resume to Sadhika - 9811174195.

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

Role & responsibilities Manage insurance claims from receipt to settlement, ensuring timely processing and resolution. Coordinate with TPAs (Third Party Administrators) for claim adjudication and settlement. Handle mediclaim claims, health insurance claims, and other types of general insurance policies. Ensure accurate billing and reconciliation of patient accounts. Maintain records of all interactions with patients, providers, and insurers. Preferred candidate profile 5-8 years of experience in insurance coordination or TPA coordination role. Strong knowledge of insurance billing, claims processing, and claims settlement procedures. Proficiency in handling multiple tasks simultaneously under tight deadlines. Excellent communication skills for effective interaction with customers (patients), providers (hospitals), and insurers. Perks and benefits As per industry

Knowledge, Skills & Ability: Knowledge in US Mortgage business and servicing claims process in specific. Ability to read through and understand FHA, VA loans, HUD demands, Title packages & Re-Conveyance. Ability to manage multiple clients and processes assigned. Should have good knowledge in Claim package, post-sale & REO new file setup. Strong written and verbal communication skills and ability to converse with client & can make decisions based on the situation. Strong analytical, logical approach and data management skills. Good understanding of reports and performance management. Comfortable with flexible work timings including India late night shift to cover PST clients and willingness to extend work hours based on business need. Should have excellent command on MS-Office (Excel, PPT, Word, Visio is an added advantage) Should have excellent e-mail/phone etiquette. Ability to handle & accomplish multiple tasks, follow written & verbal instructions effectively & understand & perform basic financial transactions. Ability to work under stringent deadlines and work with the team to meet deadlines. Must be a team player and can manage the team by leading as a role model. Responsibilities: Supervise and lead a group of associates to meet all SLAs relative to all functions in the department. Maintain daily, weekly, and monthly production reports along with MBR and QBR including preparing Decks across all processes managed including circulating minutes. Monitor work allocation, pipeline management daily across all processes managed. Coordinate activities of the department with the manager to include workflow monitoring, process improvement, training, reporting and special projects. Provide recommendations for strategies and process improvements to add value to teams and clients. Coordinate with other internal support teams to ensure seamless production by the operations team. Responsible for team Attendance and team retention. Identify talent and mentor next level leaders. Create and Manage SOP for all processes handled along with periodic updates. Other Requirements: Minimum of 4 years of US Mortgage experience Proficiency in Claims Processing and Underwriting Willingness to work in Night Shifts Willingness to work on weekends based on Client requirement.

We are hiring medical officers for cashless claims processing. Ideal candidates have 0-2 years in TPA/insurance with BAMS/BHMS. Strong medical knowledge and understanding of health policy terms are required.

Roles and Responsibilities Manage accounts receivable processes, including invoicing, cash applications, and claims processing. Perform daily reconciliations to identify and resolve any discrepancies.

Project Role : Application Developer Project Role Description : Design, build and configure applications to meet business process and application requirements. Must have skills : GuideWire ClaimCenter Good to have skills : NAMinimum 7.5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As a Business Architect, you will be responsible for leading current state assessments and identifying high-level customer requirements, defining the business solutions and structures needed to realize these opportunities, and developing a business case to achieve the vision. Your typical day will involve working with GuideWire ClaimCenter and collaborating with cross-functional teams to create tangible business value for the client. Roles & Responsibilities:- Lead current state assessments and identify high-level customer requirements.- Define the business solutions and structures needed to realize opportunities.- Develop a business case to achieve the vision.- Collaborate with cross-functional teams to create tangible business value for the client.- Utilize expertise in GuideWire ClaimCenter to deliver impactful solutions.- Work directly with the client gathering requirements to align technology with business strategy and goals- GuideWire ClaimCenter ie FNOL, claim closure, exposures, reserves- Good experience in Property and Casualty- Working knowledge of SOAP / REST web service - Should be able to create/ consume the web services in Java - Understanding of XML, XSD- Knowledge of messaging, plugins Professional & Technical Skills: - Must To Have Skills: Expertise in GuideWire ClaimCenter.- Good To Have Skills: Experience in business architecture and solution design.- Strong understanding of business processes and requirements gathering.- Experience in developing business cases and delivering impactful solutions.- Excellent communication and collaboration skills.- Good to have Guidewire Developer in Integration/ Configuration, GOSU scripting and Java Enterprise Edition- Good to have Experts internally and externally for their deep functional or industry expertise, domain knowledge, or offering expertise- Basic SQL and Database knowledge Additional Information:- The candidate should have a minimum of 7.5 years of experience in business architecture and solution design.- The ideal candidate will possess a strong educational background in business, technology, or a related field, along with a proven track record of delivering impactful solutions.- This position is based at our Bengaluru office. Qualification 15 years full time education

About Plum Plum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations. Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance. Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners. About the role The primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred. PRINCIPAL ACCOUNTABILITIES Processing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy. Responsible for the following transactional activities Scrutiny of reimbursement claims Submission to Insurer Informing incomplete documentation requirement to the employees Liaising with employees in explaining the reason for requirements/plum rejections Leading team of claims experts who guides the employees to submit the claims Collaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submission Communicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepancies Maintaining accurate records of claims processing activities and documentation for audit and reporting purposes. Providing customer service support to address inquiries and concerns related to reimbursement claims. Working with Insurance companies to ensure that eligible claims are paid completely to the end customer

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 year About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skills. Written and verbal communication. Collaboration and interpersonal skills. Ability to meet deadlines. Process-orientation Roles and Responsibilities: Your expected interactions are within your own team and direct supervisor. You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments. The decisions that you make would impact your own work. You will be an individual contributor as a part of a team, with a predetermined, focused scope of work. Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skillsWritten and verbal communicationCollaboration and interpersonal skillsAbility to meet deadlinesProcess-orientation Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation