Clinical Client Policy Data Analyst Zelis

1.0 - 5.0 years

0 Lacs

hyderabad, telangana

On-site

You will play a crucial role in supporting various initiatives that enhance the healthcare financial experience at Zelis India. Your responsibilities will include reviewing claims within the Clinical Coding Policy queues and maintaining up-to-date clinical guidelines for these claims. You will also analyze specific coding scenarios, assist in edit ideation, and provide root-cause analysis of edit performance issues. Communication and teamwork are essential as you collaborate with the team and leadership to ensure edits are working as intended and to support decision-making with validation data. As the Clinical Coding Policy Analyst, you will work closely with leadership on departmental functions and special projects, as well as with resolution analysts. Your role will involve creating and maintaining job aides to promote consistency in clinical validations and claims workflow process improvements. Additionally, you will assist in submitting IT requests for enhancements and maintaining industry knowledge of claim edit references from organizations such as AMA, CMS, and NCCI. To excel in this role, you must be a Certified Coder (CCS, CCS-P, or CPC) with a preferred background as an RN, LPN, or LVN. You should have a solid understanding of claims workflow, the ability to interpret claim edit rules and references, and apply industry coding guidelines to claim processes. Experience in reviewing Medical Records and applying NCCI editing is necessary, along with proficiency in manipulating data in Excel and managing business relationships. Excellent verbal and written communication skills are vital for effective collaboration and documentation. In addition, you will need a bachelor's degree or equivalent certification such as an active CPC credential. Your role will involve maintaining updated process guidelines, enhancing automation, and documenting improvements to ensure high standards of service delivery. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, Zelis India provides a dynamic environment for professional growth and a holistic workplace experience. Your contributions will be instrumental in upholding Zelis" award-winning culture and optimizing technology and processes for efficiency and effectiveness.,

Posted 1 week ago

Apply

Non Motor Underwriting - Leading General Insurance Response Informatics

5.0 - 9.0 years

0 Lacs

pune, maharashtra

On-site

You will be responsible for creating and maintaining a sustainable portfolio in line with the underwriting policy of the company for Property, Engineering, Marine, and Miscellaneous Lines of Business (LOB) for both retail and SME channels. With a minimum of 5 years of experience, you will independently underwrite commercial lines products such as Property & Engineering, Marine, and Miscellaneous LOB for the retail and SME channels. Your key duties will include preparing quotations in full compliance with the company's approved guidelines and policies, reviewing all incoming quote requests, providing quotes within specified timelines, and ensuring profitable bottom-line results. Additionally, you will assist Senior Management in preparing data and various Management Information Systems (MIS), participate in system and product development, conduct claims reviews, branch audits, adhere to underwriting authority guidelines in terms of discounts, sum insured, and products, analyze profitability, maintain MIS reports, and prepare dashboards. Building and maintaining strong relationships with internal customers such as the Sales Team, Operations Team, and Claims Team, as well as external customers and channel partners, will also be crucial for success in this role.,

Posted 4 weeks ago

Apply

Regulatory Affairs Executive Krishnaenterprise Ac

3.0 - 6.0 years

3 - 6 Lacs

Ahmedabad

Work from Office

Regulatory Affairs Executive ( for Cosmetic Industry ) Kheda, Gujarat 3–5 Years Experience CTC up to 6 LPA Strong knowledge of global cosmetic regulations (EU/USA/ASEAN/Gulf) Expertise in labeling, claims review, and documentation

Posted 1 month ago

Apply

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.