646 Health Claims Jobs - Page 18

Roles and Responsibilities Manage a team responsible for investigating fraudulent activities related to health claims. Conduct thorough investigations into suspected cases of insurance fraud, gathering evidence and interviewing witnesses as needed. Develop and implement effective strategies to prevent future instances of fraud through risk control measures. Collaborate with other teams within the organization to ensure seamless communication and coordination during investigations. Ensure compliance with regulatory requirements and company policies throughout all aspects of claim investigation.

Responsibilities: Ensure timely claim settlements within policy limits. Manage health claims from intake to payment. Process mediclaim & TPA claims with accuracy. Collaborate with insurers on claim resolution. Health insurance Annual bonus

Positions General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processin...

POSITION: MEDICAL OFFICER/CONSULTANT 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 Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) 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 th...

Hiring for leading MNC company Interview Mode: Face-to-Face Interview Location: Noida & Gurgaon Exp Req: 0 to 5 Yrs Qualification: BPT, MPT, BUMS, BAMS, BHMS only Key skills: Claim Processing, Knowledge of Healthcare and coding, Knowledge of health insurance, CPT, CMC Work mode: WFO 5 days working Weekends fixed off Cabs available Salary: up-to 5 LPA Interview Dates: Gurgaon: 12/7/2025 (Saturday), 15/7/2025 (tuesday) Noida: 15/7/2025 (tuesday) Interested candidates call or WhatsApp on this number: 8700871235. Share your Cv on this email: amanaxisconsulting@gmail.com

Join our dynamic international business team across Bangalore and Hyderabad Job Description Claims Service Support (CSS) - AM/Manager Summary: We at Prudent Insurance Brokers, are seeking an experienced Employee Benefit-Claims Service Support professional for our International Business (IB) vertical. Employee Benefits Practice at Prudent is a strategic business unit dedicated to strengthening Prudent’s global brand in the international market. The individual will be responsible to Serve as primary point of contact for all employee claim queries etc. We are committed to delivering bespoke Benefit & Total Reward Solutions with high standards of service excellence, world-class advisory and cons...

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

The candidate must have completed BHMS, BAMS, or BUMS from a reputed university." Experience : 0 to 2 years Locations : Bangalore, Chennai and Mumbai / Pune Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and control...

Clients business problem to resolve : At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our companys growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. Clients Business problem to solve? Our Client is one of Leading Health Plan in US providing services in Florida state , NTT are getting into contract with Client to manage End to End Claims Administration services. Our NTT Business Process...

Claims processing Doctor Job Description: Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance. With the medical expertise ,need to master the various products and to apply the same during claim processing. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. List of Responsibilities: To validate the authenticity and the credibility of the claims. To coordinate with various persons (Claimant, Treating...

Basic Function Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems. Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision. Perform leave administration tasks as required, including recertification of health condition, intermittent claim track...

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred L...

Looking for an Accounting Receivable Specialist with 1+ year of U.S. medical billing experience, knowledge of EOBs, denials, CPT codes, and U.S. insurance. Must work U.S. shifts from Pune. Healthcare experience required. Provident fund

Role & responsibilities To be able to process P & A claims as a Claims Manager Preferred candidate profile Any Graduate with experience of minimum 1year with P&A Claims experience in Health

Role & Responsibilities Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Outstanding follow-up with TPA. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies...

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 Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) 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 a...

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 Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift 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 d...

POSITION: MEDICAL OFFICER/CONSULTANT 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 Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 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 ...

We are hiring medical officers for cashless claims processing. Ideal candidates have 0-2 years in TPA/insurance with BAMS/BHMS. Strong medical knowledge and understanding of health policy terms are required.

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 year About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their custom...

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer ...

Skill required: HM- Utilization Management - Healthcare Management Designation: Customer Service Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do Embedding digital transformation in healthcare operations...

Skill required: Claims Services - Claims Administration Designation: Health Admin Services New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do Embedding digital transformation in healthcare operations e...

Responsibilities: * Manage patient care in emergencies * Conduct claim investigations * Process health claims * Adjudicate claims fairly * Collaborate with TPAs on case resolution

Walk-in Drive || Clinical Doctors || Cotiviti Pune || IPDRG || Fresher & Experienced || Walk-in Date : 12th Jul 25 Walk-in Time : 10 AM to 2 PM Job Location : Pune Venue : COTIVITI INDIA PRIVATE LIMITED - Plot C Binarius Building 190 / 192 Plot C, Deepak Complex, National Games Road Off Golf Course, Shastrinagar, Yerawada, Pune, Maharashtra 411006 Eligibility : Fresher Eligibility Criteria : Medical Degree (MBBS or BAMS or BHMS or BPT) with Clinical experience or US Healthcare experience Strong analytical, critical thinking and problem solving skills Should have general knowledge on Medical Procedures, Conditions, illness & Treatment Practices Excellent verbal and written communication skill...