272 Health Claims Jobs

Healthcare Insurance Decoding - 3 roles Location: Koramangala, Bangalore Hospital: Superhealth Hospitals Pvt. Ltd. Salary: Up to 50,000/month (Based on experience) Are you experienced in decoding health insurance policies and working with TPAs Join our dynamic Revenue Cycle team and help us ensure transparency and clarity in patient coverage. *Key Responsibilities:* Decode and interpret insurance policy benefits and terms Support billing and pre-auth teams with accurate policy data Liaise with TPAs and insurers for real-time information Maintain digital records and ensure compliance *Eligibility:* 24 years of hospital/TPA experience Proficient in reading policy documents and benefit charts Strong in communication and detail-oriented CONTACT HR PRIYA AT 9739398219 CANDIDATE SHOULD HAVE EXPERIENCE AS A TPA AND HAD WORKED IN HOSPITAL MANDATORY.

Job Title: Motor Insurance Claims Handler (Bodily Injury Focus) Location: Bangalore Employment Type: Full-Time Department: Claims / Insurance Operations Reports To: Claims Team Lead / Claims Manager Job Summary: We are seeking a skilled and detail-oriented Motor Insurance Claims Handler with experience in bodily injury claims . The successful candidate will be responsible for managing and processing motor insurance claims efficiently and fairly, with a specific focus on bodily injury liability, third-party damages, and personal injury claims. This role requires strong analytical skills, empathy, and knowledge of motor insurance policies, local legislation, and medical terminology. Key Responsibilities: Handle and manage a portfolio of motor insurance claims, including bodily injury and third-party liability cases. Assess the validity of claims through careful investigation and policy review. Liaise with policyholders, third parties, medical providers, legal professionals, and law enforcement. Obtain and analyze medical reports, police reports, and other relevant documentation. Negotiate settlements in accordance with legal guidelines, policy terms, and internal procedures. Maintain accurate records of claim decisions and supporting documentation in the claims management system. Collaborate with legal and fraud teams where litigation or fraudulent activity is suspected. Keep up to date with changes in legislation and case law relevant to motor and injury claims. Ensure claims are processed within regulatory and internal timeframes. Deliver high-quality customer service during the claims lifecycle. Required Qualifications & Experience: Proven experience (1+ years) handling motor claims , specifically bodily injury or third-party personal injury . Familiarity with local insurance regulations and liability assessment. Experience working with medical terminology and understanding of injury classification. Knowledge of claims management systems and insurance software. Excellent verbal and written communication skills. Strong negotiation, analytical, and decision-making skills. Ability to manage multiple claims with attention to detail and urgency. Preferred Qualifications: Degree in Law, Insurance, Risk Management, or a related field. Insurance certifications. Experience with litigation claims or working with external legal counsel. Soft Skills: Empathy and tact when dealing with injured parties or sensitive situations. Integrity and professionalism. Resilience and ability to work under pressure. Collaborative mindset and team orientation. Contact Point : Deepanshu - 9900024811 / 9686682465 / 7259027282 / 7259027295 / 7760984460

Job Title: Inbound Contact Representative Industry: Healthcare (Voice Process) Experience: Minimum 3 years in Customer Service Preferred: Associate's or Bachelor's degree. Experience in an inbound call center . Healthcare domain experience (voice process only) is a strong plus. Role & responsibilities Handle incoming calls , emails, or written inquiries from customers. Provide support for benefit queries , issue resolution, and customer education. Document customer interactions and take appropriate actions. Escalate unresolved complaints as needed. Perform routine to moderately complex admin and customer support tasks . Make decisions within defined guidelines, using some independent discretion. Work with minimal supervision while meeting quality and timing standards.

Role & responsibilities:- HEAPS is a health tech platform and Software as a Service (SAAS) provider which leverages advanced data analytics, artificial intelligence and machine learning to revolutionize healthcare delivery and payments model by building a Healthcare Network and a Value Based Care model. Responsibilities:- Provide patients with the psychosocial support needed to cope with chronic, acute or terminal illnesses Communicate with patients suffering from various ailments post discharge to understand the status of their health and counsel them To enroll new patients into the system once they call in Role & responsibilities HR Contact Details:- HR Mahek Contact No:- 7559401618

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 Bangalore Educational Qualification Shift BHMS, , BAMS, Pharm D 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

Role & responsibilities:- HEAPS is a health tech platform and Software as a Service (SAAS) provider which leverages advanced data analytics, artificial intelligence and machine learning to revolutionize healthcare delivery and payments model by building a Healthcare Network and a Value Based Care model. Responsibilities:- Provide patients with the psychosocial support needed to cope with chronic, acute or terminal illnesses Communicate with patients suffering from various ailments post discharge to understand the status of their health and counsel them To enroll new patients into the system once they call in Role & responsibilities HR Contact Details:- HR Namrata Contact No:- 8624868754

About the Team The Claims team at Navi is responsible for delivering a fast, transparent, and customer-first claims experience. From initial intimation to final settlement, whether cashless or reimbursement, they manage the end-to-end process with a strong focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and use data-driven insights and process automation to improve claim resolution speed and customer satisfaction. About the Role The role involves end-to-end medical claims adjudication, including reviewing treatment records, verifying eligibility, identifying potential fraud, and making informed claim decisions. It requires coordination with providers, customers, and internal stakeholders to ensure TAT and SLA adherence. The Medical Officer is also expected to support cost negotiations and assist in claim analytics. Strong communication, regulatory knowledge, and problem-solving skills are essential, along with a background in medicine. What We Expect From You Reviewing and evaluating medical claims to determine their eligibility for payment Investigating medical claims to identify fraud Communicating with claimants, providers, and other parties involved in the claim Making decisions about medical claims, such as whether to approve or deny a claim Negotiate with the treating doctor/ hospital to reduce the unjustified hospitalization cost Automate the system and bring in improvements to claims processes Monitoring systems and processes to ensure sustained levels of performance Liaison with internal stakeholders to ensure the deadlines of TATs and SLAs & Work towards the designated Tasks Tracking of customer communication for effective grievance resolution within TAT & SLAs Knowledge of products, regulations, and guidelines is a must to ensure process compliance. Claim Analytics- Periodical claim analysis to identify fraud and monitor claim performance metrics. Informing the customer about the rejection of their claim through a call Team Management- Build and manage a team of processing doctors supporting the function Must Haves Ability to handle independent assignments & having the acumen to draw logical conclusions He/she should have a broad understanding of Claims Practice Sharp business acumen to understand health insurance claim servicing needs Excellent communication skills, including writing reports and presentations Ability to anticipate potential problems and take appropriate corrective action Knowledge of health regulations, IRDA circulars is a must. Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Candidates having data analytics experience would be an added advantage. Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Inside Navi We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal & Home Loans to UPI, Insurance, Mutual Funds, and Gold, we are building tech-first solutions that work at scale, with a strong customer-first approach. Founded by Sachin Bansal & Ankit Agarwal in 2018, we are one of India's fastest-growing financial services organisations. But we are just getting started! ` Our Culture The Navi DNA Ambition. Perseverance. Self-awareness. Ownership. Integrity. We are looking for people who dream big when it comes to innovation. At Navi, you'll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you're driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each otherand that starts with every one of us. Why You'll Thrive at Navi At Navi, it's about how you think, build, and grow. You'll thrive here if: Youre impact-driven : You take ownership, build boldly, and care about making a real difference. You strive for excellence : Good isn’t good enough. You bring focus, precision, and a passion for quality. You embrace change : You adapt quickly, move fast, and always put the customer first.

Role & responsibilities Greetings from The Job Factory !! Job Summary: We are seeking highly motivated and enthusiastic undergraduate or graduate freshers/ experience to join our team as International Process Associates. The successful candidates will work on international processes, providing exceptional service to our global clients. For more details Call : HR Shruthi 9008812627 (call or whatsapp) Email id - shruthic@thejobfactory.co.in Role & Responsibilities: 1. Handle customer inquiries and resolve issues via phone, email, or chat 2. Provide product information and support to customers 3. Manage and document customer interactions 4. Meet productivity and quality standards 5. Collaborate with internal teams to resolve complex issues Preferred Candidate Profile: 1. Undergraduate or graduate degree in any discipline 2. Excellent communication and interpersonal skills 3. Ability to work in a fast-paced environment and manage multiple priorities 4. Strong analytical and problem-solving skills 5. Willingness to learn and adapt to new processes and technologies What We Offer: 1. Competitive salary and benefits 2. 2-way cab facility for commute 3. Opportunities for growth and development in a global company 4. Collaborative and dynamic work environment 5. Training and support to help you succeed in your role 6. Incentives and Allowance's Skills: 1. Good communication skills (written and verbal) 2. Basic computer knowledge and typing skills 3. Ability to work independently and as part of a team 4. Strong attention to detail and organizational skills For more details Call : HR Shruthi 9008812627 (call or whatsapp) Email id - shruthic@thejobfactory.co.in Preferred candidate profile

Role & responsibilities Greetings from The Job Factory !! Job Summary: We are seeking highly motivated and enthusiastic undergraduate or graduate freshers/ experience to join our team as International Process Associates. The successful candidates will work on international processes, providing exceptional service to our global clients. For more details Call : HR Devishree 9901195084(call or whatsapp) Email id - devishreethejobfactory@gmail.com Role & Responsibilities: 1. Handle customer inquiries and resolve issues via phone, email, or chat 2. Provide product information and support to customers 3. Manage and document customer interactions 4. Meet productivity and quality standards 5. Collaborate with internal teams to resolve complex issues Preferred Candidate Profile: 1. Undergraduate or graduate degree in any discipline 2. Excellent communication and interpersonal skills 3. Ability to work in a fast-paced environment and manage multiple priorities 4. Strong analytical and problem-solving skills 5. Willingness to learn and adapt to new processes and technologies What We Offer: 1. Competitive salary and benefits 2. 2-way cab facility for commute 3. Opportunities for growth and development in a global company 4. Collaborative and dynamic work environment 5. Training and support to help you succeed in your role 6. Incentives and Allowance's Skills: 1. Good communication skills (written and verbal) 2. Basic computer knowledge and typing skills 3. Ability to work independently and as part of a team 4. Strong attention to detail and organizational skills For more details For more details Call HR Gayathri @ 9538878905 Email ID - gayathri@thejobfactory.co.in Preferred candidate profile

Role & responsibilities Greetings from The Job Factory !! Job Summary: We are seeking highly motivated and enthusiastic undergraduate or graduate freshers/ experience to join our team as International Process Associates. The successful candidates will work on international processes, providing exceptional service to our global clients. For more details Call : HR Devishree 9901195084(call or whatsapp) Email id - devishreethejobfactory@gmail.com Role & Responsibilities: 1. Handle customer inquiries and resolve issues via phone, email, or chat 2. Provide product information and support to customers 3. Manage and document customer interactions 4. Meet productivity and quality standards 5. Collaborate with internal teams to resolve complex issues Preferred Candidate Profile: 1. Undergraduate or graduate degree in any discipline 2. Excellent communication and interpersonal skills 3. Ability to work in a fast-paced environment and manage multiple priorities 4. Strong analytical and problem-solving skills 5. Willingness to learn and adapt to new processes and technologies What We Offer: 1. Competitive salary and benefits 2. 2-way cab facility for commute 3. Opportunities for growth and development in a global company 4. Collaborative and dynamic work environment 5. Training and support to help you succeed in your role 6. Incentives and Allowance's Skills: 1. Good communication skills (written and verbal) 2. Basic computer knowledge and typing skills 3. Ability to work independently and as part of a team 4. Strong attention to detail and organizational skills For more details For more details Call : HR Devishree 9901195084(call or whatsapp) Email id - devishreethejobfactory@gmail.com Preferred candidate profile

Review and interpret diagnostic and clinical reports Summarize patient findings in a standard reporting format for clients/insurance partners. Ensure accuracy and consistency in medical terminology and conclusions.

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Client Servicing Responsible for developing the corporate customer base for MDIndia Health Insurance Services. Map the territory and maintain a strong pipeline of potential customers. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. Develop strong relationship with Insurance Companies/Brokers. Promptly attending Emails, Phone calls, Whats App messages of Clients. Maintain proper MIS & Internal reports and present it to the management. Ability to work independently, achieve targets and be absolutely result oriented Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive Two wheeler is Mandatory If interested kindly share your resume to ta4@mdindia.com

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 insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-5 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Role & responsibilities:- HEAPS is a health tech platform and Software as a Service (SAAS) provider which leverages advanced data analytics, artificial intelligence and machine learning to revolutionize healthcare delivery and payments model by building a Healthcare Network and a Value Based Care model. Responsibilities:- Provide patients with the psychosocial support needed to cope with chronic, acute or terminal illnesses Communicate with patients suffering from various ailments post discharge to understand the status of their health and counsel them To enroll new patients into the system once they call in Role & responsibilities HR Contact Details:- HR Namrata Contact No:- 8624868754

Hiring For Blended Process related to US Healthcare Gurgaon/Noida Graduate Fresher (No.Btech) Any UG/Grad with 1 yr exp. can apply Salary - 16k-23k inhand 5 days working Sat/Sun fixed off Fixed night shifts Both side cab Anjali: 9354911705 Required Candidate profile Candidates should have super excellent communication skills Candidates should be immediate joiner Candidates should be comfortable in Night shift and WFO Perks and benefits Meal/Medical Both side cab Sat &Sun off

Job Summary Join our dynamic team as a Claims Processing Specialist where you will play a crucial role in ensuring the accuracy and efficiency of claims adjudication. With a focus on Medicare and Medicaid claims you will contribute to the seamless processing of claims enhancing our service delivery. This hybrid role offers the flexibility of working both remotely and on-site during night shifts. Responsibilities Process claims with precision ensuring adherence to Medicare and Medicaid guidelines. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Utilize claims adjudication software to enhance processing efficiency. Provide feedback on process improvements to enhance service delivery. Maintain up-to-date knowledge of industry regulations and compliance standards. Communicate effectively with stakeholders to ensure clarity and resolution of claims issues. Document claims processing activities accurately for audit and reporting purposes. Support the team in achieving departmental goals and objectives. Participate in training sessions to stay informed about the latest claims processing techniques. Ensure confidentiality and security of sensitive claims information. Contribute to a positive work environment by supporting colleagues and fostering teamwork. Adapt to changing priorities and work effectively under pressure. Qualifications Demonstrate proficiency in claims adjudication processes and software. Possess strong analytical skills to identify and resolve claims discrepancies. Exhibit excellent communication skills for effective stakeholder interaction. Show a keen understanding of Medicare and Medicaid claims requirements. Display attention to detail in processing and documenting claims activities. Have the ability to work independently and collaboratively in a hybrid work model. Certifications Required Not required

Job Details: Job Process/Role: Claims Adjudication (US Healthcare) Experience: 1 - 3 Years of Relevant experience in Claims adjudication Skillset: CPT Codes, HIPAA, Co-pay and Co-insurance, Medicaid and Medicare, Denial claims, UB and CMS forms. Shift: Night shift Location: Chennai Mode of Work: Work from the office Notice Period Eligible: Immediate to 30 Days of Notice period is acceptable. Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials. Knowledge in handling authorization, COB, duplicate, pricing, and the 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 insurance industry and of all products, services, and processes performed by the team. Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication, and the adjustment process. Experience in professional (HCFA), institutional (UB) claims (optional). Both undergraduates and postgraduates can apply. Good communication (Demonstrate strong reading comprehension and writing skills). Able to work independently, with strong analytical skills. 1. Required schedule availability for this position is Monday-Friday, 5.30 PM/3.30 AM IST (AR SHIFT). The shift timings can be adjusted according to client requirements. 2. Additionally, resources may have to work overtime and on a weekend basis to meet business requirements.

Job Description: Job Title : Senior Medical Officer Investigation Team Department : Investigation Location : [Insert Office Location] Reports To : Head Claims Investigation Employment Type : Full-time Job Purpose: The Senior Medical Officer will lead and support the investigation team by reviewing, evaluating, and investigating health insurance claims to ensure medical appropriateness and detect fraud, waste, or abuse. The Senior Medical Officer will act as a bridge between medical knowledge and investigator, playing a key role in ensuring fair and accurate claim settlements. Key Responsibilities: Evaluate high-value and suspicious claims by reviewing medical documents, patient history, and treatment records. Verify and scrutiny the claim documents. Guide and supervise field medical officers and investigators in collecting and interpreting clinical information. Identify inconsistencies, over-utilization, or fraudulent patterns in medical claims. Handle escalations and responding to mails accordingly. Support legal or compliance teams in preparing medical reports or expert testimony in fraud cases. Assist in preparing MIS reports, audits, and documentation related to claim investigation outcomes. Ensure adherence to IRDAI guidelines and internal medical policy frameworks. Train and mentor junior medical officers and non-medical investigators on claim evaluation practices. Productivity ( Achieve the daily targets ) Maintaining TAT Required Qualifications & Skills: Experience: Minimum 57 years ( in clinical practice and/or health insurance, with at least 2 years in claim Auditing) Strong knowledge of medical procedures, diagnostics, hospital protocols, and insurance norms Excellent analytical and documentation skills Good communication and interpersonal skills to coordinate with medical and non-medical stakeholders Decision Making Analytical Skills Familiarity with health insurance fraud indicators and regulatory compliance Proficiency in using medical claim systems and MS Office tools Industry Type : Insurance Department: Health care & Life Science Education: Preferred Attributes: Prior experience in a health insurance company, TPA, or investigation agency

You would be responsible for managing the end-to-end claims process for clients, ensuring seamless handling from claim intimation to settlement follow-ups. You will be the key point of contact for clients and AMCs regarding claim processes. You should be strategic and detail-oriented, ensuring timely documentation, filing, and resolution of claims while also contributing to business growth through lead generation and upselling. Requirements You have a bachelors degree in administration, commerce, or a related field. 2-3 years of hands-on experience in insurance claims processing. Ability to communicate correctly and clearly with all customers. Maintain a positive attitude with a focus on customer satisfaction. Documentation and organizational skills.

Immediate joiners or with in 15 days Salary goes up to 6LPA-6.5LPA Graduates with minimum 1.5 years into the specified domain, Sat, Sun fixed off ,2 way cab Fixed uk shift White field location Note : Experience candidates only - on same domain

Greetings from NTT DATA, 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 insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Job Responsibilities: ***ONLY BHMS GRADUATES CAN APPLY.*** Having experience (at least 5 yrs) in TPA claim processing. Having a Good relationship with Hospitals under the East Zone. Financial Contribute to renewal portfolio expansion through relationship building with the insurance companies and surveyors to ensure optimum claim settlement in minimum time During processing of claim analyse the following and communicate to underwriters: adequacy of sum insured anomalies in the policy scope of additional policies other related information Control expenses Business Process Facilitate proper settlement of the claim in the shortest possible time to the satisfaction of the client by ensuring the following: Obtain complete information on the loss from the client after initial intimation Submit intimation to the insurance company for Registration of claim Allocation of a surveyor Obtain LOR (List of Requirements) from the Surveyor Match LOR with the Salasar requirement already taken from the client and take rest of the documents Once documents are received, check exclusions in fine print and prepare the draft reply from client submitted to insurance company Follow up with client for repair and reinstatement for early completion and help in documentation of estimate, contractor details, expenses etc. so that surveyor gets structured inputs for preparation of the survey report Follow up with surveyor for completion of assessment Communicate surveyors comments to client in terms of estimate and exclusion and arrange meeting between surveyor and client to resolve differences to obtain client assessment Ensure surveyors report is submitted at the earliest Follow up with insurance company for early settlement of claim Obtain settlement voucher from insurance company and forward to client Get discharge of client (signoff) and submit to insurance company for disbursement Update each step in SAIBA on real time basis and ensure due IRDA compliance Ensure resolution of all complex technical issues in claims and timely escalation of the same for quick disposal of the claim Customer Support the marketing department in obtaining new business and ensuring best possible coverage for client, talk to technical dept of client to understand which risks need to be covered, type of production (continuous/ batch) Reopen claims in case of new businesses and follow up to obtain claims after reopening of file by insurance company if repudiation is not time-barred Participate in fortnightly meetings to give updates to the business development and client servicing teams on the status of claims in order that they are updated about the same before meeting client for renewals Interface with clients to reinforce relationship with existing clients Prepare and submit daily / monthly reports on status of claims People Growth Acquire product knowledge and always keep self updated with latest variations in product offerings Attend training sessions (external/ internal) and working on on-job assignments to implement new learning Conduct training sessions for marketing team as well underwriting and claims teams to build product knowledge across functions Set objectives, review and evaluate performance periodically and give feedback Review pending work and initiate action Perform all such duties which are required to be performed by this position in an insurance broking house in general course and to perform all such duties and carry out all such responsibilities so delegated or asked to be performed by the Designated Authority from time to time External Interface: Internal interface: Existing clients Prospective clients Insurance companies Employees Preferred Competencies of Incumbent a) Functional Competencies Demonstrates domain knowledge in own area of operation Understands product offerings Understands service standards as per the Organization's ethos Learns continuously and keeps self-updated b ) Leadership Competencies : Relationship Building Networks effectively with both external and internal customers Focuses on building long-term, sustainable relationships Delivers on commitment every time Creative & Analytical Problem Solving Understands the strategic objectives of the Organization, unit, and function Collates data and analyses them objectively Takes objective decisions based on data to achieve the strategic objective of the Organization Goes the extra mile to achieve creative solutions Customer Focus Designs solutions that meet the requirements of the customer (external/ internal) Demonstrates a sense of urgency to resolve all external and internal customer concerns and responds to queries and requests within defined timelines and processes Educates customers (external/ internal) about changes in processes, policies and offerings Creates long term relationships with customers (external/ internal) through continuous interface Obtains customer (external/ internal) feedback to improve processes Promotes loyalty and converts customers to brand ambassadors Achieves customer delight concerning both internal and external customers Is sensitive to the code of conduct in the office and customer establishments Perseverance Makes every possible effort to understand the viewpoints of external and internal customers Takes all possible steps to resolve issues Understands the importance of deadlines, proactively removes roadblocks, and delivers as per requirement Tries alternatives to achieve the target Does not give up in the face of adversity Explains own point of view assertively to get necessary support and approval Is patient and persistent towards follow-up on all leads and prospects generated during the past, towards new client acquisition Achievement Orientation Understands the strategic objectives of the Organisation, unit, and function Aligns individual and team targets with strategic goals Plan and deploy appropriate resources to meet targets in the short and long term Goes the extra mile to achieve targets as per committed timelines and enables the team to do so Achieves and motivates excellence irrespective of circumstances Shares best practices across businesses Benchmarks with the best and continuously raise the bar Upgrades competencies of self and team to achieve excellence Interested candidate can share their CVs at susweta@salasarserviecs.com

Vidal is hiring for claim Processor Designation: Executive-Claims Location: Gurgaon, Key Responsibilities: Review and validate claim documents submitted by hospitals or insured members Scrutinize medical records and bills for completeness and accuracy Apply policy terms, conditions, and exclusions to adjudicate claims Perform ICD and procedure coding as per ailment and treatment Coordinate with medical officers for clinical opinion when required Maintain claim logs and update CRM systems with claim status Ensure adherence to defined SLAs and minimize processing errors Flag suspicious or potentially fraudulent claims for investigation Communicate with stakeholders for clarifications or missing documents Support audit and compliance teams with documentation and reports Shortfalls & Queries Required Skills & Competencies: Strong understanding of health insurance policies and TPA workflows Familiarity with medical terminology and coding (ICD, CPT) Attention to detail and analytical thinking Proficiency in claims processing software and MS Office tools Good written and verbal communication skills Ability to manage high volumes under pressure Commitment to confidentiality and data protection norms Qualifications & Experience: Graduate in any discipline (preferably life sciences or healthcare) 1-3 years of experience in claims processing within a TPA or insurer

Job Details: Job Process/Role: Claims Adjudication (US Healthcare) Experience: 1 - 3 Years of Relevant experience in Claims adjudication Skillset: CPT Codes, HIPAA, Co-pay and Co-insurance, Medicaid and Medicare, Denial claims, UB and CMS forms. Shift: Night shift Location: Chennai & Coimbatore Mode of Work: Work from office Notice Period Eligible: Immediate to 30 Days of Notice period is acceptable. Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials. Knowledge in handling authorization, COB, duplicate, pricing, and the 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 insurance industry and of all products, services, and processes performed by the team. Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication, and the adjustment process. Experience in professional (HCFA), institutional (UB) claims (optional). Both undergraduates and postgraduates can apply. Good communication (Demonstrate strong reading comprehension and writing skills). Able to work independently, with strong analytical skills. 1. Required schedule availability for this position is Monday-Friday, 5.30 PM/3.30 AM IST (AR SHIFT) . The shift timings can be adjusted according to client requirements. 2. Additionally, resources may have to work overtime and on a weekend basis to meet business requirements.

operations of the healthcare claims processing team (Mediclaim, RCM, and denial management) Ensure claims, including verification, validation, coding .Monitor & manage denials, rejections, and appeals in accordance with Payer & Provider guidelines. Required Candidate profile knowledge of healthcare claims, RCM workflows, & denial management. Should have Team Management , Client Management. Analyze RCM data to identify trends, gaps, & opportunities for process improvement