272 Health Claims Jobs - Page 11

Urgent requirement for BDS/MBBS-Chennai( Kilpauk ) Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: MBBS / BDS graduate. MBBS Candidate Should be MCI Registered BDS Candidate Should be DCI Registered Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Venue details: MDIndia Health Insurance TPA Pvt. Ltd. No: 226 , OM Sakthi Towers Kilpauk Garden road, Kilpauk, Chennai-600010.

Urgent requirement for BHMS,BDS,BAMS -Hyderabad Fresher/Expereince candidate should have atleast 1 year of TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BHMS,BDS,BAMS graduate Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Only Male Doctor required for Field Investigation

Any Graduate 06 months exp in insurance domain or Property and casualty Book Roll Endorsement Underwriting Call/Whatsapp RASHMI 8130669625 Required Candidate profile 1 Year bpo experience Candidate must be okay with walkin interview Excellent communication skills required.

Walk-In Interview registration will end by 11:00AM Job responsibilities : Processing of Health Claims. Claim Registration and Claim Adjudication. Identifying the Frauds. Adhering to SLAs and processing the claims with in the TAT as per policy terms and conditions. Supporting CRM, Provider, sales and grievance teams Office Address: Tata AIG General Insurance Company Limited, C/o Imperial Towers, Floor-5, Landmark - Next to Metro (Ameerpet) Station, Ameerpet, Hyderabad

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak Hindi & Malayalam. CTC – Upto 3.5 LPA.

Ready to shape the future of work? At Genpact, we don't just adapt to change we drive it. AI and digital innovation are redefining industries and were leading the charge. Genpacts AI Gigafactory, our industry-first accelerator, is an example of how were scaling advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. From large-scale models to agentic AI, our breakthrough solutions tackle companies most complex challenges. If you thrive in a fast-moving, tech-driven environment, love solving real-world problems, and want to be part of a team thats shaping the future, this is your moment Genpact (NYSE: G) is an advanced technology services and solutions company that delivers lasting value for leading enterprises globally. Through our deep business knowledge, operational excellence, and cutting-edge solutions we help companies across industries get ahead and stay ahead. Powered by curiosity, courage, and innovation, our teams implement data, technology, and AI to create tomorrow, today. Get to know us at genpact.com and on LinkedIn, X, YouTube, and Facebook. Inviting applications for the role of Process Associate - Underwriting Support! Your role will require you to utilize your experience in and knowledge of insurance/reinsurance and underwriting processes to process transactions for the Underwriting Support Teams and communicate with the Onsite Team. Responsibilities • Transaction processing for Underwriting Support Teams • Knowledge of Market Reform Contract (Slip), it's sections and details such as written line, Sign Line etc. as well as carrier generated policy documentation. • Exposure to London Market i.e., Company and Bureau markets is preferable. • Invoice production and provision of credit control support • Responsible to comprehend, good customer service attitude to clearly articulate the resolution. • Responsible to balance dynamic volumes of workloads and to reach targets and deadlines on a timely basis. • Data collection, formatting, and analysis • Document production, collection, and distribution • Supporting client teams in the UK and liaising with their colleagues on a multi-national basis • Operational support with multiple activities for client service teams Qualifications we seek in you! Minimum Qualifications • Graduate (in any discipline) • Should have knowledge of Insurance lifecycle. • Demonstrate and cultivate customer focus, collaboration, accountability, initiative, and innovation. • Proficient in English language- both written and oral Preferred Qualification • Insurance domain awareness • P&C Underwriting knowledge • Good knowledge of MS Office • Higher certifications preferred- LM1 & LM2 Why join Genpact? * Be a transformation leader Work at the cutting edge of AI, automation, and digital innovation * Make an impact Drive change for global enterprises and solve business challenges that matter * Accelerate your career Get hands-on experience, mentorship, and continuous learning opportunities * Work with the best Join 140,000+ bold thinkers and problem-solvers who push boundaries every day * Thrive in a values-driven culture Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress Come join the tech shapers and growth makers at Genpact and take your career in the only direction that matters: Up. Lets build tomorrow together Genpact is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion or belief, sex, age, national origin, citizenship status, marital status, military/veteran status, genetic information, sexual orientation, gender identity, physical or mental disability or any other characteristic protected by applicable laws. Genpact is committed to creating a dynamic work environment that values respect and integrity, customer focus, and innovation. Furthermore, please do note that Genpact does not charge fees to process job applications and applicants are not required to pay to participate in our hiring process in any other way. Examples of such scams include purchasing a 'starter kit,' paying to apply, or purchasing equipment or training.

Role: Senior Manager/Manager - Health Claims (Claims Processing) Job location: Goregaon East Role & responsibilities Experience: 2+ years (preferably with Insurer/TPA) Key Responsibilities: Process and review health insurance claims in line with policy and regulatory guidelines. Verify clinical documents (discharge summaries, prescriptions, medical reports) for claim validation. Coordinate with TPAs, brokers, and clients for claim-related queries and document collection. Manage client escalations related to claim disputes or delays. Review and reject claims where necessary, providing clear reasons and communication Ensure compliance with health insurance regulations and company policies. Prepare reports on claim processing status and outcomes. Suggest process improvements to enhance efficiency and accuracy. Qualifications & Skills: Degree in BAMS, BHMS, MBBS, or Dentistry. Minimum 2 years experience in health claims processing with insurers or TPAs. Good understanding of insurance products, claims procedures, and regulatory requirements. Strong analytical, communication, and coordination skills. Proficient with MS Office and claims management tools. Ability to handle multiple tasks and client interactions effectively.

Check the medical admissibility of claim by confirming diagnosis and treatment details Verify the required documents for processing claims and raise an information request in case of an insufficiency Approve or deny claims as per T&C within TAT If candidates are interested please drop your update resume/CV on my WhatsApp no - 8951865563 Thanks & Regards Sarika Email - sarika.pallap@mediassist.in

Managing CGHS, ECHS, CAPF and ESIC and All Government Portals: Medical file Audit Claim Processing Uploading Query Management Required Candidate profile Mandatory practical experience of government empanelment such as CGHS ECHS ESIC CAPF etc. and medical file audit and processing for Railways, CGHS, ECHS and other govt empanelment's.

We Have Urgent Requirement of TPA Manager

Looking for Fresher candidates Fresher graduate health insurance claim validation

Role: Closed file review & audit 1-Handling closed / open file review for third party administrator & inhouse claims 2-Recoveries from third party administrator for claims processed with errors 3-Highlight areas of improvement 4-Monthly reports to be published Candidate must have: 1-In-depth knowledge of medical cases with exposure to ailment treatments, policy coverages for OPD/hospitalization/personal accident/ travel claims 2-Good interpersonal skills 3-Must be proactive & effective learner 4- Must have previous experience of Audit 5- Good Analytical, Communication and Negotiation skills 6- Familiar with Basic Microsoft Excel and regulatory changes 7- Minimum 7 years of experience in general insurance Accident & Health claims Qualifications Degree in medicine (BHMS/BAMS/MBBS) At Liberty General Insurance , we create an inspired, collaborative environment, where people can take ownership of their work; push breakthrough ideas; and feel confident that their contributions will be valued, and their growth championed. We have an employee strength of 1200+ spread over a network of 116+ offices in 95+ cities, across 29 states. Our partner network consists of about 5000+ hospitals and more than 4000+ auto service centers. We believe and live by our values every day - Act Responsibly, Be Open, Keep it Simple, Make things better and Put People First. For learning about our key USPs, you can go visit our website. Working with Liberty also provides you an opportunity to experience One Liberty Experience . We create the One Liberty experience through Providing Global exposure to employees by including them in cross country projects that gives them opportunities to work with diverse teams within & outside India. Fosters Diversity, Equity & Inclusion (DEI) to create equitable career opportunities Flexi Working arrangements. If you aspire to grow & build your capabilities to work in a global environment, Liberty is the place for you!

Skill required: HM- Utilization Management - Healthcare Management Designation: Customer Service New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.The administration of hospitals, outpatient clinics, hospices, and other healthcare facilities. This experience includes day to day operations, department activities, medical and health services, budgeting and rating, research and education, policies and procedures, quality assurance, patient services, and public relations. What are we looking for? Healthcare Utilization Management Ability to work well in a team Adaptable and flexible Commitment to quality Process-orientation Written and verbal communication Health Insurance Portability & Accountability Act (HIPAA) Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Skill required: HM- Utilization Management - Healthcare Management Designation: Customer Service Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.The administration of hospitals, outpatient clinics, hospices, and other healthcare facilities. This experience includes day to day operations, department activities, medical and health services, budgeting and rating, research and education, policies and procedures, quality assurance, patient services, and public relations. What are we looking for? Healthcare Utilization Management Adaptable and flexible Ability to work well in a team Commitment to quality Written and verbal communication Process-orientation Health Insurance Portability & Accountability Act (HIPAA) Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

About Navi Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a Navi_ite : 1. Perseverance, Passion and Commitment Passionate about Navis mission and vision Demonstrates dedication, perseverance, and high ownership Goes above and beyond by taking on additional responsibilities 2. Obsession with high-quality results Consistently creates value for the customers and stakeholders through high-quality outcomes Ensuring excellence in all aspects of work Efficiently manages time, prioritizes tasks, and achieves higher standards 3. Resilience and Adaptability Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility Key Responsibilities: Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations Reviewing and evaluating medical claims to determine their eligibility for payment Investigating medical claims to identify fraud Making decisions about medical claims, such as whether to approve or deny a claim Negotiate with the treating doctor/ hospital in reducing the un-justified hospitalization cost Automate system and bring in improvements on claims processes Monitoring systems and processes to ensure sustained levels of performance Liaison with internal stakeholder to ensure the deadline of TAT’s and SLA’s & Work towards Designated Tasks Tracking of customer communication for effective grievance resolution within TAT & SLA’s Compliance- Through knowledge of products, regulations, guidelines is must to ensure process compliance all the time. Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics. Informing the customer about the rejection of their claim through call Involves identifying discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements What are some of the good to have skills for this role? Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Experience in handling audit Background in claims processing with clinical experience in a hospital setting Data analytics experience would be an added advantage Ability to handle independent assignments & having the acumen to take logical conclusions 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. Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.

Skill required: HM- Utilization Management - Healthcare Management Designation: Customer Service New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.The Healthcare Delivery team focuses on the process of providing care to patients including hospital departments, clinical services and other functions integral to the patient journey. What are we looking for? Healthcare Utilization Management Ability to work well in a team Adaptable and flexible Commitment to quality Process-orientation Written and verbal communication Health Insurance Portability & Accountability Act (HIPAA) Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

Skill required: Claims Services - Payer Claims Processing Designation: Health Admin Services New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.In Payer Claims Processing you will be responsible for delivering business solutions that support the healthcare claim function, leveraging a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims. What are we looking for? Adaptable and flexible Ability to perform under pressure Ability to work well in a team Commitment to quality7-9 months experience in Claims processing Claims Processing Claims Administration Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

TPA Liaison: Serve as the primary point of contact between the hospital and TPAs, ensuring smooth claims processing and reimbursement. Collaborate with TPAs to verify patient eligibility, approve pre-authorizations, and facilitate smooth discharge procedures. Ensure timely submission of claims, follow up on outstanding claims, and resolve any discrepancies or issues related to TPA reimbursements. Corporate Client Coordination: Act as a liaison for corporate clients, addressing their queries and ensuring employees medical needs are met efficiently. Coordinate with corporate clients to manage employee health programs, including corporate insurance policies, wellness programs, and preventive health check-ups. Assist in the onboarding of corporate clients and ensure smooth setup for hospital services under corporate agreements. Claims Management: Monitor, track, and process claims submitted by patients under TPA and corporate agreements. Ensure all claims meet the required documentation and regulatory standards. Resolve claim issues and disputes in a timely manner, coordinating with both internal departments and external stakeholders. Documentation and Reporting: Maintain accurate records of all communications, claims, approvals, and payments from TPAs and corporate clients. Prepare regular reports on claims processing status, pending approvals, and financial reconciliations for internal and external stakeholders. Ensure all documentation is organized, up-to-date, and compliant with hospital policies and industry regulations. Customer Service: Provide exceptional customer service to patients, TPAs, and corporate clients by addressing inquiries and concerns promptly. Ensure patients and their families understand the process of claiming insurance and managing payments through TPAs or corporate policies. Cross-Functional Collaboration: Work closely with the billing, finance, and medical teams to ensure that patient care is seamless, and claims are processed efficiently. Collaborate with other hospital departments (admissions, discharge, accounts) to resolve any patient-related issues concerning TPA and corporate coverages. Compliance and Regulations: Stay updated with the latest regulations, policies, and procedures related to TPAs, corporate healthcare programs, and insurance claims. Ensure all processes align with the hospitals standards, legal requirements, and industry best practices. Key Skills and Qualifications: Education: Bachelors degree in healthcare management, business administration, or related fields. Experience: 1-2 years of experience in TPA management, corporate healthcare coordination, or insurance claims processing is preferred. Skills: Strong communication and interpersonal skills to interact with TPAs, corporate clients, and internal teams. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and hospital management systems. Ability to handle sensitive and confidential patient information. Attention to detail and strong organizational skills to manage multiple tasks simultaneously. Problem-solving skills to resolve claims and coordination issues. Working Environment: The role typically operates in an office setting within the hospital or remotely, with periodic visits to patient care areas or meetings with external stakeholders. The job may involve working with insurance companies, corporate representatives, and patient families, requiring professional demeanor and strong customer service skills.

Role & responsibilities: Analyzing and summarizing medical records for pre and post settlement projects. Interpreting clinical data in terms of medical terminology and diagnosis. Adhering to company policies/ARCHER principles and hence taking good care of Archer culture. Adhere to Health Insurance Portability and Accountability Act (HIPPA) all the time. Daily reporting to Medical team lead for productivity & quality EDUCATIONAL QUALIFICATION AND EXPERIENCE REQUIRE: MBBS graduate (No experience required) BHMS/BAMS graduate (Minimum 2 years of experience with Claims Processing in the Insurance sector).

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: 3-8 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. Interested Candidate Please share me your Resume to Ganga.Venkatasamy@nttdata.com

Investigate health insurance claims, verify medical records, detect fraud, conduct field visits, and prepare detailed reports. Coordinate with hospitals and ensure compliance with TPA policies and IRDAI guidelines. Medical background preferred.

Skill required: Claims Services - Payer Claims Processing Designation: Health Admin Services Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.Business solutions that support the healthcare claim function, leveraging a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims. What are we looking for? Contract conversion Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation