3155 Claims Processing Jobs - Page 9

Job Title: Insurance Executive Company: Kauvery Hospitals Job Description: We are seeking a motivated and detail-oriented Insurance Executive to join our team at Kauvery Hospitals. The Insurance Executive will be responsible for managing all aspects of patient insurance verification, processing claims, and ensuring compliance with healthcare regulations. This role involves collaborating with patients, insurance providers, and internal departments to facilitate smooth insurance operations and enhance the patient experience. Key Responsibilities: - Verify patient insurance eligibility and benefits before services are rendered. - Accurately process insurance claims and ensure timely submission....

Reviewing & analysing discrepancies by cross-verifying from different data sources Understanding of medical coding, billing & medical terminologies Defines, communicates & data coordination to support various implementation related reports Required Candidate profile B.Pharma, B.P.T, BSC Life Science ,BDS with 2 Yrs Exp in US Healthcare claims Excellent Communication skills in Written and Verbal Comfortable with Night Shift info.aspiringmantra@gmail.com

Role & responsibilities The Program Specialist should: • Proficient in English, verbal and written • Easily navigate between multiple computer programs with dexterity • Adheres to schedule and meets deadlines. • Demonstrate solid customer service skills. • Understand each customers needs and tailors responses with those needs in mind • Express empathy while speaking with customers. • Be motivated to help customers every day and operate with a sense of accountability and urgency. • Thrive working in a very scheduled and collaborative work environment while also being able to work independently. • Adhere to schedule and meets deadlines. • Express thoughts and instructions clearly in both oral ...

Role & responsibilities Adjudicate claims activities like setting up new claims, making payments, refunds, updating reserves, adding vendor details, etc. in Legacy as well as a new environment called Global Claim System (GCS). Liaising with Claim handlers onshore, brokers, and underwriters. Manage all administration aspects of the claim Preferred candidate profile Graduate / Postgraduate with relevant years of experience within Insurance/Reinsurance industry. Positive, innovative, and make it better mindset to bring operational efficiencies. Experience in MS Excel and PowerPoint is required support segment KPI and management reporting.

Role Summary Key Accountabilities/ Responsibilities Stakeholder interfaces Experience Education

Key Responsibilities 1. Billing Process Management Develop and implement efficient billing processes and procedures. Establish guidelines and controls to ensure accurate and timely billing, including invoice generation, payment tracking, and collections. Continuously review and optimize billing workflows to improve efficiency and accuracy. 2. Invoicing and Billing Accuracy Ensure that all invoices are accurate, complete, and compliant with relevant regulations and contractual agreements. Review billing data, verify billing rates, and apply appropriate discounts or promotions. Identify and resolve billing discrepancies or errors promptly. 3. Billing System Administration Oversee the administr...

JOB DETAILS 1. Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies 2. Adhere to the state and federal compliance policies and contract compliance 3. Assist the prospective team with special projects and reporting 4. This process works on identifying discrepancies between medical records and billed services 5. Identifying Up-coding, Duplication, and Misrepresentation of services 6. Managing and reporting adverse events and serious adverse events 7. Reviewing clinical study protocols, reports and study documentations 8. Supervising ...

Job Track Description: Requires experience in a professional, sales, or technical area through formal education. Performs technical-based activities. Contributes to and manages projects. Uses deductive reasoning to solve problems and make recommendations. Interfaces with and influences key stakeholders. Leverages previous knowledge and expertise to achieve results with teams and can complete work self-guided. A college or university degree required. General Profile Requires in-depth knowledge and experience. Uses best practices and understanding of business issues to improve products and services. Solves complex problems. Takes a new perspective using existing solutions. Works unaided and re...

Greetings From Scorelabs Inc! Claims Management Process for all the Health product line and portfolio Co-ordinate with multiple teams and stakeholders e.g. Underwriting, Hospitals, Claims. Evaluation of Health Claim Ratio Location - Hyderabad Required Candidate profile Any Medical Graduate like BAMS, BHMS, BUMS , MBBS etc. Minimum 1-3 years of relevant experience of practice or healthcare industry. Freshers & Exp both are eligible Hr Gowthami - 7842272470

Oversee all general and group medical insurance policies, timely renewals, and prompt premium payments. Work closely with HR, Finance, and insurance providers for employee coverage updates, premium settlements, and receipt of policy documents. Required Candidate profile Graduate with experience in handling General Insurance policies in large corporates are preferred. Must have very good relation with service provider for competitive quotations. Age : 34-46 yrs .

Roles and Responsibilities: 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. 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 d...

Note: Apply only if fine to work at hospital and location Job Description: * Updating records and files in portal * Knowledge in computers like MS office. * Usage of company platform for patients data updation. * Database management. * Good interpersonal skill. * Coordination with other team members and internal department of the hospital * Share daily activity report to the reporting manager

Skills: Fresher, freshers, bangalore, noida, chennai, hyderabad,. Company Overview. CN Solutions is a leading IT services and IT consulting company that specializes in providing first-class solutions for manpower requirements. With a team of experienced and dedicated professionals, we excel in identifying and short-listing potential candidates based on client-specific requirements. Our range of services includes Staffing Solutions, Leadership Hiring, RPO, General Staffing, and Contract and Full-time Hirings. Job Overview. Male Candidates of Indian origin between 18 to 30 years of age. Trainees should be able to READ any one Indian language. Must have an address & ID Proof. Terms & Conditions...

JOB TITLE Technical Business Analysis Engineer II RESPONSIBILITIES May perform one or more of the following: Requirement/Analysis Ability to comprehend Business Requirement Documents (BRD) Maintain and Update Data/Vendor Interfaces BRD Interprets requirements to create systems specifications documents to build and execute system. Perform Data Analysis, Audit, and associated research and provide subsequent resolutions. Understanding of database/SQL Query Writing Work alongside with Sr. members or individually (as required) to assist in smooth integration/transition of processes and create/maintain documentations for the same. Responsible for solving the data and Vendor files related issues an...

Job Track Description: Requires relevant expertise through formal education in a professional, sales, or technical area. Performs technical-based activities. Contributes to and manages projects. Uses deductive reasoning to solve problems and make recommendations. Interfaces with and influences key stakeholders. Leverages previous knowledge and expertise to achieve results. Able to complete work self-guided. College or university degree required or equivalent work experience. General Profile Performs routine assignments. Exposure to fundamental theories and concepts. Develops skills by performing structured work assignments. Uses existing procedures to solve routine or standard problems. Rece...

Position Summary : As a Demo Speaker at NxtWave, you will be responsible for conducting demo sessions in person with parents and students and engaging them, and driving enrollment in the NIAT (NxtWave Institute of Advanced Technologies) program. The ideal candidate is a motivated communicator with excellent language proficiency, and a passion for helping students succeed in tech careers. Key Responsibilities : 1. Demo Sessions & Presentations : Conduct demo sessions for parents and students, showcasing the benefits of NxtWaves NIAT product and how it prepares students for high-paying tech roles. Present the value proposition clearly, emphasizing the programs potential to boost future career ...

About The Role This job involved leading a team whose primary role involved in supporting the data entry updates/ gathering required information / documents to support claim finalization. As part of the role the teams review images and documentation received with regards on the claims and as per guidelines update the information into the system and perform follow ups with vendor for the required information. Managing tasks and workflows in accordance to set standards and ensuring necessary claims processing guidelines are being adhered to through the process. Handling new hire training and transitions for the scope of services. Will need to have a high interest in driving domain certificatio...

Role & responsibilities Team management: Supervise and guide a team of claims processors, delegating tasks, setting performance goals, and conducting regular performance reviews. Claim processing oversight: Monitor and manage the day-to-day workflow, ensuring claims are processed accurately, efficiently, and in a timely manner. Quality assurance: Review claims submissions to ensure they are compliant with policy terms, conditions, and relevant healthcare regulations. Problem-solving: Investigate and resolve complex and escalated claims issues, including discrepancies, in an accurate and timely manner. Training and development: Provide training and support to team members to enhance their ski...

Job description In this Role you will be Responsible For : Read and understand the process documents provided by the customer. Entry-level administrative operations support performing various basic tasks (mail, file services, reporting, project support, and general account support activities). Analyze the insurance request received from the customer and process as per standard operating procedures. Familiarize, navigate multiple client applications and capture the necessary information to process customer request. Provides basic-level of support on programs, projects, reporting, filing (electronic and hard-copy), confidential materials handling, and issue resolution. Scope of work is routine...

JrExecutiveTPA Billing is overall responsible for providing expert coordination service between insurance company&patient to help them availcashlessservice at the hospitalThe job also involves preparing bill as per insurance TPAs Schedule of Charges

Oversee daily nursing operations, ensuring high-quality patient care.Develop and implement nursing policies and procedures to maintain excellence.Collaborate with medical staff to develop and implement patient care plans Required Candidate profile Proven experience as a Nursing Superintendent or Nursing Incharge. Strong leadership and management skills, with the ability to motivate teams. Excellent communication and interpersonal skills

Perform orthopedic surgeries with precision and care. Conduct thorough examinations and diagnoses to determine the best course of treatment.Develop and implement effective treatment plans for patients Required Candidate profile Strong knowledge of medical services and hospital operations. Excellent communication and interpersonal skills. Ability to work well under pressure and make quick decisions.

Perform complex neurological surgeries with precision and care. Conduct thorough examinations and diagnoses to determine the best course of treatment. Develop and implement effective treatment plans for patients. Required Candidate profile Strong understanding of neurological anatomy and physiology. Ability to work well under pressure and make quick decisions. Excellent communication and interpersonal skills.

Mandate ASK : Experience: 1-3 yrs in claims adjudication Location : Chennai , Coimbatore Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insur...

Must be MBBS certified or have 2+ yr exp with Claim processing and be a BHMS Shift - UK Shift Female - 3-9 from office (9pm-12pm from home) Male - 3pm-12 work from office CTC upto 8.5 LPA