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1.0 - 5.0 years
3 - 6 Lacs
Navi Mumbai
Work from Office
Job Title : P&C Claims Management Qualification : Any Graduate and Above Relevant Experience : 1 to 5 years Must Have Skills : 1.Experience in P&C Claims Management, preferably with BPO/Insurance process exposure. 2.Strong experience handling FNOL (First Notice of Loss) or FROI (First Report of Injury) cases. 3.Knowledge of claims systems like Guidewire, Duck Creek, Majesco, or similar platforms. 4.Familiarity with ISO, NCCI, and WCIRB reporting requirements. 5.Proficient in MS Office (Excel, Word) and data entry with attention to detail. 6.Strong communication and interpersonal skills with a customer-centric approach. 7.Ability to multi-task in a fast-paced and compliance-driven environment. Good Have Skills : knowledge and expertise in FNOL (First Notice of Loss) or FROI (First Report of Injury) Roles and Responsibilities : 1.Manage end-to-end claims processing for Property & Casualty lines including auto, home, general liability, and workers compensation. 2.Perform FNOL/FROI intake, assess coverage, and initiate claim setup using internal systems. 3.Verify policy information, document incidents accurately, and identify subrogation opportunities. 4.Maintain consistent communication with policyholders, claimants, vendors, and internal teams. 5.Support claims adjudication by gathering and reviewing supporting documentation, police reports, medical records, etc. 6.Ensure compliance with applicable state regulations and client-specific SLAs. 7.Coordinate with adjusters, underwriters, and legal teams where necessary. 8.Generate and maintain accurate records for audit and reporting purposes. 9.Continuously identify and escalate potential fraud or misrepresentation concerns. 10.Participate in process improvement initiatives and training sessions. Location : Mumbai CTC Range : 3.5 to 6 LPA (Lakhs Per Annum) Notice Period : Immediate Mode of Interview : Virtual Shift Timing : Night Shift Mode of Work : Work From Office Thanks & Regards, Aneesha HR Analyst Black and White Business Solutions Pvt Ltd Direct Number : 08067432440| Whats app : 9035128021|aneesha.g@blackwhite.in
Posted 1 week ago
0.0 years
3 Lacs
Thane
Work from Office
UK Health Care Process Nature of Work : Claim Processing/ Backend Candidates should have their own system and internet connection Configuration required Windows 10 Processor - i3/i5 RAM - 4 GB Speed - 10mbps rotational shifts, 5 days working Required Candidate profile Rounds of Interviews - HR - Medical Test - Email Test - Amcat - Ops
Posted 1 week ago
1.0 - 2.0 years
0 - 1 Lacs
Hyderabad
Work from Office
1) Receiving of claims courier sent by employees 2) Segregation of claims according to department, 3) Validation of employee claims as per the Travel policy, GST requirements and Eligibility by following internal processes and SOPs in CRM 4) Communication of status of claim process and related queries and updates by e-mail and CRM 5) Coordinate by calling the employees on disputed balance confirmations and clarifying the doubts and get the confirmations 6) Preparing of weekly exception and pending claims report and GST sheets 7) Follow up mails in case of no revert 8) Accounting of Claims into weekly batch, 9) Writing file numbers on the accounted claims and filing of the hard copies of the claim in order of file numbers 10) Capture of GST details and Invoice segregation and scanning of invoices to handover to tax team
Posted 1 week ago
1.0 - 3.0 years
2 - 3 Lacs
Chennai
Work from Office
Greetings from Alldigi Tech!!! Job Description: HealthCare (non-Voice) Shift: Day Shift (9am to 6pm) Experience: 1 to 3 years Notice Period: Immediate Joiners Connecting with our client's business partners in the US, typically insurance companies to follow up and coordinate on the following activities: Coordinates medical specialty referrals and procedures for patients in a timely, efficient, and equitable manner Utilizes EMR system(s) to track and research urgent requests and keep patient information current and accurate Communicates information, including updates of referral requests, appointment details, and communication preferences vis EMR, email, chat, and patient portal Review patient charts and records to understand what authorizations and documentations need to be pursued Ensures that all barriers to care (such as language, transportation restrictions, or financial needs) are addressed Provides clear, thorough, and accurate documentation of all referral processing steps, in the patient's electronic health records Processes necessary prior authorizations and insurance referrals as needed to complete the referral process Follows organizational guidelines regarding the use of the Electronic Medical Record (EMR) in compliance with HIPAA and patient confidentiality standards Maintains access to the Health Information Exchange (HIN) and other related systems Uses HIN and other related systems to gather information needed to coordinate care and keep patients' electronic health records up to date with the status of care that is being coordinated Maintains surveillance ticklers and/or work with Health Information Technology to proactively identify the need for patient care Navigates patient to care, as assigned. Interested candidates can come for the Direct Walk-In Interview to the office.
Posted 1 week ago
1.0 - 2.0 years
2 - 3 Lacs
Gandhinagar, Ahmedabad
Work from Office
Hiring for a Record Retrieval Specialist #Shift-Us Shift Timing #Location: Ahmedabad, Gujarat # Minimum 6 months of Experience Required in the International Voice process #Fluent English Required Meal Facility is also available
Posted 1 week ago
2.0 - 4.0 years
3 - 4 Lacs
Surat
Work from Office
Responsibilities: * Lead claims settlements and operations on-site * Ensure compliance with HIPAA & insurance ops standards * Manage health claims of our patients from start to finish * Collaborate with stakeholders on claim resolution
Posted 1 week ago
14.0 - 20.0 years
22 - 32 Lacs
Kochi
Work from Office
Candidate must have experience in service delivery, transitions, process excellence, transformational leadership, and solutioning Required Experience - Healthcare Operations + Transitions Candidate must be green/black certified, good with transformation concepts Shift - US Location - Kochi Essential Functions The role will manage a single or multi-client portfolio in healthcare domain with span of control of ~400 - 500 employees The role will be responsible for ensuring noiseless delivery across the accounts, working closely with the onshore teams to support sales opportunities, and moving each of the delivery accounts towards Intelligent (a combination of leveraging AI, robotics, and analytics effectively) The responsibility would be to manage multiple teams who would work from different offshore locations for US Helathcare payer business Preferably experience with Claims, Appeals, Utilization management, Back office enrollment, prior Auth Engage with various existing support teams (Process Excellence/ Digital / Analytics) that will help us achieve the results Manage relationships with customers at the senior management level and ensure customer satisfaction Establish and maintain robust tracking mechanism for key indicators of the operations to support decision-making Responsible for tracking and driving all process parameters critical to quality for process delivery Assist management with career development activities for team members, team leaders and managers, including performance management, feedback and training Ensure adequate guidance & training of team members to ensure process objectives & Customer requirements are met Profession Skills Requirement Operational Skills Prior work experience in managing US Healthcare payer client/s independently in a third-party organization. Need to have management skills to manage large teams and take both top line & bottom line responsibilities Candidate should have ability to respond rapidly and creatively address problems and opportunities, to devise solutions that address the business needs. Proven track record of managing and growing businesses Ability to work in a matrix organization and be sensitive to cross cultural/geographical sensitivities Ability to create a strategy, implement it and be operational at the same time. Soft skills An effective communicator with excellent relationship building, Negotiation & interpersonal skills Versatility, High level of professionalism and confidence Strong leadership skills and the ability to effectively and efficiently manage others Highly flexible, adaptable and creative Strong analytical, problem solving abilities & complexity management Respond to business problems or challenges with new perspectives and explore a variety of relevant possible solutions. Take prompt and effective action to rectify problems and bring structure and clarity when managing within unstructured, ambiguous environments. Self-motivated, able to work independently and under pressure, resourceful, self-driven with a strong sense of commitment and multitask management are pre-requisites
Posted 1 week ago
1.0 - 5.0 years
1 - 4 Lacs
Ahmedabad
Work from Office
Medusind Solutions Openings for AR Callers/ WFO Location : Ahmedabad ( 7th & 8th Floor, Corporate Rd, Makarba, Ahmedabad, Gujarat 380015 ) HR : Rohan 878007771 Role & responsibilities Outbound calls to insurances for claim status and eligibility verification Denial documentation and further action Calling the insurance carriers based on the appointment received by the clients. Working on the outstanding claims reports/account receivable reports received from the client or generated from the specific client software. Calling insurance companies to get the status of the unpaid claims. Willing to work in any process pertaining to voice based on the requirement (Insurance Follow UP, Patient calling, Provider outreach program etc. Maintain the individual daily logs. Performs assigned tasks/ completes targets with speed and accuracy as per client SLAs Work cohesively in a team setting. Assist team members to achieve shared goals. Compliance with Medusind' s Information Security Policy, client/project guidelines, business rules and training provided, company's quality system and policies Communication / Issue escalation to seniors if there is any in a timely manner Punctuality is expected all the time Perks and benefits Any Undergraduate 0.6-2 Years Relevant experience into medical billing Basic knowledge of MS Office Preparing spreadsheets and documents Good Communication skills must be able to fluently converse in English. Must have a neutral accent No stammering Working Day - 5 days working (Sat & sun fixed off ) Shift timing - 5.30 PM to 2.30 AM Drop Available with 25kM office radius Interested candidate can call on 878007771 or Can share their profiles rohan.shaikh@medusind.com
Posted 1 week ago
10.0 - 20.0 years
20 - 35 Lacs
Noida
Work from Office
Amity Software Limited is in the business of offering Insurance Industry solutions to various insurance companies in the world - both P&C Insurance as well as Life Insurance. For these projects, we need a Insurance Industry Expert as SUBJECT MATTER EXPERT (Insurance) to help implement our Insurance Software solutions. Roles and Responsibilities Process Study and Requirement Gathering. Client Process Improvement suggestions Functional Requirements Document (FRD) preparation. User Flow / Process Flow Charts, Diagrams documentation. Role & Responsibilities: Responsible for finalizing Business Requirements from the insurance company and document the same effectively in Functional Requirements Document (FRD) with the help of a team of Business Analysts. Perform detailed analysis of existing processes to ensure that all aspects of the business requirements are understood & mapped. To act as an expert on insurance industry and advise our clients about improvements in their processes and business practices. Prioritize requirements and negotiate with users so as to keep the user expectations manageable and within the scope of work. Capture details and document these in Functional Requirements Document (FRD) for creating the computerized system. Act as an EXPERT on Insurance Domain and to advise our clients on various aspects of insurance business and processes. Review various UI and screens so as to ensure that these are best possible interfaces considering user needs and expectations. Go through the developed software to satisfy himself/herself that the developed system is as per user needs and data flow is perfect. Design and conduct User Training Sessions. Design Study material for Training. Reviewing Change Requests from users before passing them on to Technical Team. Help create us pre-sales material. Review process part in business proposals, which are to be submitted to prospective Insurance Companies. Requirements for the Position Qualification: Graduate/MCA/B.Tech./MBA. Any training and/or specialized courses in Insurance would be an advantage. Extensive knowledge and experience in Insurance industry processes and experience at a senior level. Domain Experience : Minimum 15 years of experience as an Insurance industry professional in a Insurance Company. Both Life Insurance as well as General (P&C) Insurance domain candidates are welcome. Software Industry Experience: Previous experience as a Subject Matter Expert in any Software Company dealing in insurance domain, will be an added advantage. Knowledge of Insurance Domain : End-to-end knowledge and experience in Insurance Domain, especially in the area of P&C Insurance, Life Insurance, Health/Medical Insurance, Policy Administration, Claims Management, Reinsurance, and General Ledger. A very good understanding of processes prevailing in Insurance Companies for end-to-end Insurance Processes - Sales & marketing, Policy Administration, Underwriting, Reinsurance, Claims Management, Risk & Audit, Compliances. Communication Skills: Excellent communication skills in written and spoken English. Good inter-personal skills. Other Skills : Good personality, Excellent inter-personal skills, Must be a friendly person and certainly not an introvert. International Travel : Must have a valid passport . Willingness to travel overseas for long duration, since this position requires travel to client locations for systems study and discussions during requirements finalization phase, and later at the time of User Acceptance Testing (UAT) and Go Live. Applicants will be requires to go through a written test and interview , as part of our standard recruitment process.
Posted 1 week ago
1.0 - 3.0 years
2 - 3 Lacs
Chennai
Work from Office
We are hiring for Senior Claims Adjudication!! HR Recruiter (Reference): Abhilash Position: Senior Customer Support Associate We are looking for Candidate who has around 1 to 2 years of experience into Claims Adjudication & Claims Processing . This is a great opportunity to build your career in a dynamic and supportive environment. Venue: Firstsource Solution Limited, 5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103. Landmark: Near Vivira Mall. Shift: Flexible to work in night shift Key Skills: - Good Communication Skills. - Listening & Comprehension. - Good typing Skills is must. Work Mode: Work From Office Cab Boundary Limit : We provide cab Up to 30 km (One way drop cab | Doorstep only) Walk-In Details: Walk-In Days: Monday To Friday Walk-In Time: 10:30 AM - 2:00 PM Documents to carry: 1. Updated resume 2. Aadhar card 3. Pan card 4. Educational Certificates (1st to 6th marksheet, Provisional marksheet) 5. Previous company's Offer Letter, pay slip (last 3 months), relieving letter NOTE: 1. Mention ABHILASH (HR Recruiter) in top of your resume while walking-in for the discussion. 2. In case if you receive any other call from Firstsource for the job opportunity, be kind enough to inform that you are in touch with ABHILASH HR. 3. Share your resume to the below mentioned WhatsApp Number and Email ID . Contact: Abhilash CB 9994685103 abhilash.cbb@firstsource.com Kindly 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 Abhilash.cbb@firstsource.com
Posted 1 week ago
2.0 - 5.0 years
4 - 7 Lacs
Mumbai
Work from Office
Pfizer is looking for Healthcare Executive to join our dynamic team and embark on a rewarding career journey. Coordinating with doctors and medical staff to ensure quality healthcare services are being provided. Managing healthcare operations, including budgeting, staffing, and patient care. Monitoring and improving patient satisfaction levels. Developing and implementing policies and procedures to improve healthcare services. Ensuring compliance with healthcare regulations and standards. Collaborating with insurance providers to ensure smooth patient billing and insurance claims. Providing excellent customer service to patients and their families. Managing patient records and ensuring their confidentiality.
Posted 1 week ago
1.0 - 4.0 years
3 - 4 Lacs
Coimbatore
Remote
Walk-in interview for Sr Executive - Facets Claims - US Healthcare Skill: Claims Facets (Mandatory) , excellent communication Experience : Minimum 1yr of experience in Claims- Facets is required (Mandatory) Education : Must have regular bachelor's degree Work timings : Night shift - US timings Notice period : Immediate to Max 15 days Note: Candidates with Facets experience from US Healthcare are only eligible for the position. Please carry a hard copy of your CV & original photo ID proof for security check
Posted 1 week ago
1.0 - 4.0 years
7 - 17 Lacs
Hyderabad
Work from Office
About this role: Wells Fargo is seeking a Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6 months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education
Posted 1 week ago
1.0 - 4.0 years
3 - 4 Lacs
Hyderabad
Remote
Walk-in interview for Sr Executive - Facets Claims - US Healthcare Job description: Skill: Claims Facets (Mandatory) , excellent communication Experience : Minimum 1yr of experience in Claims- Facets is required (Mandatory) Education : Must have regular bachelor's degree Work timings : Night shift - US timings Notice period : Immediate to Max 15 days Note: Candidates with Facets experience from US Healthcare are only eligible for the position. Please carry a hard copy of your CV & original photo ID proof for security check
Posted 1 week ago
0.0 - 1.0 years
7 - 17 Lacs
Hyderabad
Work from Office
About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6 months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education
Posted 1 week ago
5.0 - 10.0 years
0 Lacs
Goregaon
Work from Office
Role: Manager/Senior Manager - Accident & Travel Claims Job location: Goregaon East Position Overview: A Claims Manager in the Accident & Travel department oversees the processing and settlement of claims related to travel accidents and incidents. They ensure timely, accurate claims assessment, manage a team of adjusters, and maintain compliance with legal and policy guidelines while delivering excellent customer service. Additionally, they are responsible for mitigating risk and resolving complex claims efficiently. Role & responsibilities: Involvement in daily claim processing Regular Updating of Claims System data Calling customers for intimation details & reminders E-mail & letter communication to customers Follow up with other departs like OPS / CC / IT for claims related matter Interaction with particular client or broker Weekly / fortnightly / monthly MIS Activity Education requirement: Bachelors Degree in business Administration, Insurance, Risk Management or related field 2-5 years of relevant Experience Required Preferred Skills Strong Analytical and problem-solving abilities
Posted 1 week ago
5.0 - 10.0 years
20 - 35 Lacs
Kolkata, Pune, Bengaluru
Hybrid
Insurance domain knowledge with Property & Casualty background Hands on exp.in at least one of the Guidewire products (Claim/Policy/Billing) Web services Job Location – Hyderabad, Bangalore, Chennai, Kolkata, Pune, Mumbai, Bhubaneshwar Exp. 2-15 Yrs Required Candidate profile Exp.on any database Oracle / SQL Server and well versed in SQL,Designed & modified existing workflows (required for Billing Integration) Exp in SCRUM Agile, prefer Certified Scrum Master Excellent
Posted 1 week ago
1.0 - 6.0 years
4 - 9 Lacs
Hyderabad, Chennai, Bengaluru
Work from Office
We are Conducting Mega Job fair for Top 10 Companies for AR calling. Chennai, Noida, Bangalore & Hyderbad. Job Title: AR Caller (Accounts Receivable Caller) Department: Revenue Cycle Management / Medical Billing Location: Bangalore / Hyderabad / Chennai / Noida Job Type: Full-Time. Experience: 0 to 10 years Job Summary: We are seeking an AR Caller to follow up on outstanding insurance claims and ensure timely reimbursement. The ideal candidate will be responsible for calling insurance companies (payers) to verify claim status, resolve denials, and secure payment for services rendered. Key Responsibilities: Call insurance companies and follow up on pending claims. Understand and interpret Explanation of Benefits (EOB) and denial codes. Identify reasons for claim denials or delays and take appropriate actions. Resubmit claims or file appeals when necessary. Document all call-related information accurately and clearly. Work with billing teams to resolve billing issues. Meet daily productivity and quality targets. Stay updated on payer policies and healthcare regulations. Required Skills: Excellent communication skills (verbal and written) in English. Basic knowledge of the US healthcare system and insurance claim process. Attention to detail and analytical thinking. Familiarity with denial management and RCM workflow is a plus. Experience using billing software like Athena, NextGen, eClinicalWorks, or similar is a bonus. Qualifications: Bachelors degree preferred, but not mandatory. Prior experience in AR calling/medical billing is an advantage. Willingness to work night shifts (for US clients). contact Hiring Manager : Mallik - 9900024951 / 7259027282 / 7259027295 / 7760984460.
Posted 1 week ago
1.0 - 6.0 years
2 - 6 Lacs
Hyderabad
Work from Office
Job Summary We are seeking a skilled professional with 1 to 6 years of experience in Claim Management to join our team in Insurance Claims. The ideal candidate will have strong expertise in MS Excel and excellent English language skills. This role requires working from the office during night shifts. Responsibilities Analyze and process annuity claims efficiently to ensure timely settlements. Utilize MS Excel to manage and organize claim data effectively. Collaborate with team members to resolve complex claim issues. Communicate clearly with stakeholders to provide updates on claim status. Ensure compliance with company policies and industry regulations. Identify opportunities for process improvements in claim management. Maintain accurate records of all claim transactions and communications. Provide exceptional customer service to claimants and beneficiaries. Conduct thorough investigations to validate claim authenticity. Prepare detailed reports on claim activities and outcomes. Support the team in achieving departmental goals and objectives. Stay updated with industry trends and best practices in claim management. Contribute to the company's mission by ensuring fair and accurate claim processing. Note Candidates with experience in insurance claims are preferred. Candidates with a notice period of 0 to 30 days are preferred. Candidates should be willing to work in night shift and work from office. This drive is only for experienced candidates and not for freshers.
Posted 1 week ago
1.0 - 4.0 years
1 - 4 Lacs
Chennai, Tamil Nadu, India
On-site
We are looking for an experienced AR Caller / Denial Management professional to join our team in India. The ideal candidate will be responsible for managing accounts receivable collections, analyzing billing issues, and ensuring timely follow-up on denied claims to maximize revenue for our healthcare organization. Responsibilities Manage and follow up on accounts receivable collections and denials. Analyze and resolve billing issues and discrepancies in a timely manner. Communicate effectively with insurance companies and healthcare providers to ensure proper payment. Review and appeal denied claims according to company policies. Maintain accurate records of all interactions and follow-up actions taken on claims. Prepare and submit appeals for denied claims with detailed documentation. Ensure compliance with applicable laws and regulations related to billing and collections. Skills and Qualifications 1-4 years of experience in accounts receivable, denial management, or healthcare billing. Strong understanding of medical billing processes and insurance verification. Proficiency in using billing software and electronic health record (EHR) systems. Excellent communication and negotiation skills. Detail-oriented with strong analytical and problem-solving abilities. Ability to work independently and manage multiple tasks effectively. Knowledge of healthcare regulations and payer guidelines.
Posted 1 week ago
3.0 - 8.0 years
3 - 5 Lacs
Kolkata, Hyderabad, Pune
Work from Office
Process cashless and reimbursment claims (Should have knowledge of processing retail policies of National/United/New India/Oriental insurance companies.
Posted 1 week ago
1.0 - 3.0 years
1 - 3 Lacs
Thane, Nashik
Work from Office
Job Title: Insurance Desk Executive TPA Coordination / Claims Specialist Location Options: KIMS Hospital, Nashik Survey No. 571/1A/1, Plot No. 63, Mumbai Agra Highway, Nashik, Maharashtra – 422001 KIMS Hospital, Thane West – Queens St, near Brentford Cooperative Society, Hiranandani Estate, Thane West, Maharashtra – 400615 Organization: Ayu Health Hospitals Experience Required: 0–2 years (Freshers are welcome to apply) Preferred Gender: Male Candidates Preferred Location: Candidates residing near hospital locations will be given preference About Ayu Health: Ayu Health is one of India’s fastest-growing healthcare networks, dedicated to making high-quality healthcare accessible and affordable for all. With a focus on technology-driven solutions, Ayu Health partners with reputed hospitals and clinics across the country to deliver standardized care, transparent pricing, and a seamless patient experience. We are on a mission to build India’s most trusted healthcare brand. Key Responsibilities: Handle insurance/TPA desk operations at the hospital premises Coordinate with TPA and insurance representatives for claim submission and follow-up Manage and organize patient insurance documentation accurately Track approvals, follow up on pending claims, and address rejections effectively Communicate professionally with patients, hospital staff, and insurance partners Support hospital administrative needs and maintain documentation records Multi-task and work collaboratively within the hospital environment Candidate Requirements: 0–2 years of experience in TPA coordination, insurance desk, or claims processing in hospitals (Freshers with good communication skills can apply) Strong interpersonal and communication skills Basic understanding of hospital processes is a plus Ability to manage documents and work efficiently under pressure Must be reliable, punctual, and a team player Preference will be given to candidates living nearby the hospital location Male Candidates only Immediate Joiners will be preferred
Posted 1 week ago
1.0 - 4.0 years
4 - 8 Lacs
Bengaluru
Work from Office
Primary Responsibilities: Review and resolve complex cases with an end to end mindset to prevent issues or inquiries from recurring. Scope open inventory for like issues for cases worked to group and resolve batches. Demonstrate a knowledge of end-to-end processes of multiple different types of capitated and delegated arrangements within the Value Based Care Model Identify and articulate trends occurring within a risk entity or across multiple risk entities within claims processing and cost share application Identify and articulate trends with our assigned delegates with the Sr. Issue Resolution Analyst and partner to work towards shift left initiatives Partner and collaborate internally and with Risk Entities to correct claims processing and cost share application errors to prevent recurring issues. Actively participate in meetings with cross functional areas aligned by risk entities to share findings Identify and communicate opportunities for improving issue resolution processes, including automation. Clearly document findings and solutions for trended issues after performing root cause analysis Perform reconciliation of member inquiry cases, respond to the specific issue of the inquiry, as well as review for and resolve other issues that may be present for the member, outside of the inquiry Support and communicate with the Sr. Issue Resolution Analyst assigned to your Delegate. Perform root cause and trend analysis of issues by assigned Delegate. Clearly document findings and solutions to prevent future issues Communicate effectively (both written and verbal) with business partners Manages emotions effectively in high-pressure situations, maintaining composure, and fosters a positive work environment conducive to collaboration and productivity Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Degree or equivalent data science, analysis, mathematics experience Experience supporting operational teams performance with reports and analytics Experience using Word (creating templates/documents), PowerPoint (creation and presentation), Teams, and SharePoint (document access/storage, sharing, List development and management) Basic understanding of reporting using Business Insights tools including Tableau and PowerBI Expertise in Excel (data entry, sorting/filtering) and VBA Proven ability to work across lines of business, claims platforms and on service provider/Delegate issues as needed Proven solid communication skills including oral, written, and organizational skills At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.
Posted 1 week ago
0.0 - 3.0 years
4 - 7 Lacs
Mumbai
Work from Office
Primary Responsibilities: To be an effective participant in Class room training and clear the training assessments with 85% quality Consistently meet the targets set for MOCK charts Eligible employee will get confirmed as Junior Coder within a max of 6 months from the Joining Punctuality, Attendance and General Adherence to company policies, procedures and practices Strives to provide ideas to constantly improve the process Ensure adherence to external and internal quality and security standards (HIPPA/ISO/ISMS) Be an effective team player Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so #NTRQ Eligibility To apply to an internal job, employees must meet the following criteria: SG 22 can apply will move laterally Performance rating in the last common review cycle of Meets Expectations or higher Not be on any active CAP (Corrective Action Plan) or active disciplinary action Time in Role Guidelines Should have been in your current position for a minimum of 12 months, if you have not met the recommended minimum time in role, discuss your career interest with your manager and gain alignment prior to applying. And share the alignment email with respective recruiter while applying Required Qualifications: Any degree in Life Science or Bio-Science Any degree in Pharmacy or Pharmaceutical Sciences Any degree in Nursing or Allied Health Any degree in Medicine At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.
Posted 1 week ago
0.0 - 5.0 years
4 - 5 Lacs
Noida
Work from Office
TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development and implementation of business plans and goals
Posted 1 week ago
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