272 Health Claims Jobs - Page 3

Urgent opening for TPA Medical Officer/customer service manager profile in Raipur, Rajkot, Kanpur, Baramati, Trivandrum locations. Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Administration. 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit Candidate must have excellent knowledge of health insurance / Health TPA domain. Candidate must have excellent bill/medical negotiation skills & customer handling skills.Good communication skills in Hindi/English and regional language of the state/region .Ready to relocate himself/herself at location within India as may be required according to the job requirement. Candidate must own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals. Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally, 20-25 Hospitals for Case Audit and Management Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management Interested candidates can share their CV on priyanka.shrivatsa@icicilombard.com or contact on 9664261933.

Urgent opening for TPA Medical Officer/customer service manager profile in Raipur, Rajkot, Kanpur, Baramati, Trivandrum locations. Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Administration. 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit Candidate must have excellent knowledge of health insurance / Health TPA domain. Candidate must have excellent bill/medical negotiation skills & customer handling skills.Good communication skills in Hindi/English and regional language of the state/region .Ready to relocate himself/herself at location within India as may be required according to the job requirement. Candidate must own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals. Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally, 20-25 Hospitals for Case Audit and Management Proficient in handling complex situations and customers. Candidate must possess clinical knowledge for evaluation of medical files Sound knowledge of surgical procedures and disease cure management Interested candidates can share their CV on priyanka.shrivatsa@icicilombard.com or contact on 9664261933.

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

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through data-driven decision-making Collaborate with cross functional teams for complex claim resolutions Timely and accurate claim settlements to avoid interest penalties Detection and prevention of fraudulent claims to reduce financial loss Accurate payout calculations aligned with policy terms Reduction in claim rework or overpayments Minimal customer complaints or escalations Timely and empathetic communication with beneficiaries Clear guidance provided throughout the claim process Claims processed within defined turnaround time (TAT) 100% compliance with regulatory and internal audit standard Effective coordination with legal and other departments Accurate and complete documentation for each claim Contributions to process improvement initiatives

Key Roles : Ensure accurate documentation and timely claim settlement Follow up with TPA and Govt. bodies for approvals/payments Strong knowledge of Govt. healthcare panels (ECHS, CGHS, ESIC, etc.) Experience in hospital billing & claim processing Annual bonus Provident fund Health insurance

Managing CGHS, ECHS, CAPF and Ayushman Bharat Government Portals: Claim Processing Audit Uploading Query Management Reconciliation and Recovery Management. Annual bonus Provident fund Health insurance

Greetingd from Niva Bupa! Key Roles & Responsibilities: Answer incoming customer calls in a professional and timely manner. Assist customers with inquiries including medical claims and rejections. Provide accurate and detailed information about claim procedures, documentation requirements, and coverage. Investigate and resolve customer concerns, ensuring high levels of customer satisfaction. Collaborate with internal departments, such as claims processing to address and resolve complex issues. Maintain thorough and up-to-date knowledge of products, medical billing codes, and claim processes. Document customer interactions and update customer records accurately in the system. Identify and escalate critical or unresolved issues to the appropriate department or supervisor. • Adhere to company policies, procedures, and compliance guidelines. Key Requirements A minimum of 1-3 years of experience in a call center environment, preferably in a healthcare or medical insurance setting. Strong knowledge of medical terminology, insurance claim procedures, and billing codes. Ability to contribute to revenue basis cross sell. • Excellent verbal and written communication skills. Ability to handle high call volumes and prioritize customer needs effectively. Strong problem-solving and decision-making abilities. Attention to detail and accuracy in data entry and documentation. Exceptional customer service skills with a friendly and professional demeanor. Proficiency in using computer systems, including customer relationship management (CRM) software and Microsoft Office Suite. • Ability to work effectively in a team-oriented environment. • Flexibility to work shifts as per business requirements. Key Requirements Education & Certificates • Any Life science, Paramedical, Medical Graduates and Postgraduates (Pharmacy, Physiotherapy, Nursing, Health education) or equivalent degree Interested candidates can walkin for the interview directly in the office Second floor, Logix Infotech Park, Sector-59, Noida from Monday to Friday from 11 am to 1:30 PM

# Location- Ahmedabad # Shift Timing: US Shift (Night Shift) # Facilities - Cab Facility # Working- 5 days # Week - Fixed off # Fluent English # Saturday, Sunday fixed off # Freshers & Experienced both can apply

Scrutiny of medical documents and adjudication Assess the eligibility of medical claims and determine financial outcomes. Ideinform the concerned department. Determine accuracy of medical documents Required Candidate profile Job Profile : Medical Officer Qualification : BHMS, BAMS, BDS Industry : Health Care Experience: 0 to 2 year Exp

Walkin : Mon to Sat between 11am to 3pm - Siruseri Unit Job Title: Insurance Co-ordinator Role & responsibilities: List out the total Number Of credit patients (All Insurance). To send the Pre- Authorization form to the concern insurance company. Explain the Admission & Discharge procedure to the patient & attenders also. All data's and activities should be computerized. Watch the approval status and query reply to be update shortly. To Proper communication about the patient Admission, Approval, Enhancement procedure, Discharge, Payment, and cancellation process. The most common job duties for a health unit coordinator are clerical tasks like answering phones and processing paperwork, including discharge, transfer, and admittance forms. Health unit coordinators also often act as a liaison between patients, nurses, doctors, and different departments within the hospital or care facility. Other tasks can include scheduling procedures like tests and x-rays, transcribing doctors' orders, and ordering medical and office supplies. Health unit coordinators are a part of a broader medical team, and are expected to keep pace with the potentially hurried and stressful environments in which they work. Heath care coordinators work closely with patients on a one-on-one basis. They provide guidance, support, and advice to patients dealing with complex medical issues. These professionals can help their clients navigate through a medical care scenario that may involve a variety of different doctors and treatment methods. Duties can include scheduling appointments, assisting with major decisions, helping patients understand complex medical information, evaluating care quality, and working with other health care professionals to ensure that the correct path is being taken. To Properly Intimate the consultants about credit limits. To make sure the Surgery details, Summary follow ups with consultants. To maintain the good rapport with consultants. Follow ups for consultant Payments. Reporting to Head of the department. Job Title: Executive - Credit Recovery Role & responsibilities: Marking Despatch details & updating claim details in KMH Internals Combinedly doing OS reconciliations as required with TPA/Corporates Sending out monthly OS statements / letters to TPA. / Corporates as may be agreed from timeline Marking Despatch details & updating claim details in KMH Internals Delivering Doctor's cheque with in time line Receiving acknowledgements for cheques submission from doctor & closing the entry in KMH DERN Collecting our Hospital other unit bills & submitting at agreed corporates. Follow up with TPA/Corporates for refund of collectible disallowance Regular follow up for renewing for MOU with TPA/Corporates Submitting Hospital Revised Tariff list to TPA / Insurance Reporting to Senior Officer - Credit Recovery Preferred candidate profile: Any Degree Holder (UG/PG Arts & Science) A minimum of 2 to 10 years of experience in Insurance. Working knowledge of Insurance standards Proficient in Microsoft Office. Strong attention to details. Perks and benefits: ESI, EPF Gratuity Contact person: Naveenkumar - HR - omrhr@drkmh.com

Hiring Clinical Doctors for Medical coding role in Mohali !! Job Location - Mohali Role : Auditor I (IPDRG) Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT Candidates with prior US Healthcare or Clinical experience will be preferred. Fresher Physicians can also apply with good clinical knowledge. Noncertified Physicians can apply however should be ready to complete the same within specified timeline. (CIC) Good communication skills. Candidates with corporate experience will be preferred. Immediate joiners preferred. Should be ready to work from office. Should be ready to work in night shift. Interested candidates can share resume - abdul.rahuman@cotiviti.com Regards, Abdul Rahuman 9080276094

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 processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. **Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Requirements for this role include: Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.

We are seeking a dynamic and detail-oriented Insurance Professional for the Legal Department to manage end-to-end insurance policy administration, claims processing, and risk management across multiple sites. The ideal candidate will have experience in insurance handling, preferably in the solar sector, and the ability to manage and coordinate across teams and insurance partners. COMPENSATION & BENEFITS: Medical Insurance Performance Incentives Cool Work Environment Travel Reimbursement (as per company policy) Exposure to challenging legal and insurance portfolios Supportive team and professional development ABOUT SADBHAV FUTURETECH LIMITED: Company Size - ~100 employees Headquarters - Gurgaon, Haryana Company Turnover - 300-350 Cr. Founded Since - Year 2020 Sadbhav Futuretech is committed to providing comprehensive and end to end solutions for farmers across India. Sadbhav addresses the major challenges of farmers through its three service verticals while ensuring value creation for all stakeholders. Our endeavor is to establish Sadbhav Futuretech as Indias first choice for solar project execution, co-operative farming, and cold chain management. We project to become the largest aggregator of farmers in India over the next 5 years. VISION: To be the largest Renewable and Agri-Tech based platform in the country impacting the lives of more than 1 million farmers over the next 10 years. OUR SPECIALITIES: Solar Agricultural Pumps, PM KUSUM Scheme, Kusum Component C, Kusum Component B, FaaS - Farming as a Service, Empowering Farmers, Solar Rooftop Solutions, Solar EPC, Solar Ground Mounted, Solar Rooftop, and Solar Solutions JOB RESPONSIBILITY: Manage complete insurance policy lifecycle, including issuance, renewals, and cancellations for company assets and projects Handle insurance claims for assets, equipment, and warehouse-related incidents Coordinate with internal stakeholders and insurance service providers for smooth claims resolution Ensure timely documentation and submission of all claims and follow-ups until settlement Analyze claim trends and risk exposure and recommend strategies for risk mitigation Maintain updated insurance-related records and compliance documentation Assist in risk assessments and inspections at warehouses and project sites Generate periodic reports and MIS on insurance coverage, claims status, and premium schedules Support internal legal compliance initiatives related to insurance law and statutory obligations DESIRED PROFILE: Minimum 3 to 4 years of experience in insurance handling and claim settlements Must hold a Diploma in Insurance or equivalent certification Experience in the solar sector or renewable energy is preferred Willingness to travel across India (30% to 40%) for on-site inspections and audits Proficient in Hindi and English (spoken and written) Strong coordination and analytical skills DESIRED SKILLS: Knowledge of general & property insurance policies (fire, asset, liability, etc.) Excellent written and verbal communication Hands-on experience in claims documentation and settlement Sound understanding of insurance laws, contracts, and coverage terms Proficient in MS Excel, Word, and reporting tools Strong negotiation and relationship management skills WHY JOIN US? • Work with a fast-growing leader in renewable energy • Be part of an organization making a sustainable impact across India • Dynamic and inclusive work culture • Opportunity to lead key insurance and legal operations independently PREFERENCE: Corporate Office; Unicorn Start-Up; Young Energetic Person

We are looking for a highly skilled and experienced AR Associate to join our team at Omega Healthcare Management Services Pvt. Ltd., Location - Omega Healthcare - F2 Airport Bengaluru, Karnataka Rustam Bagh Layout, Bengaluru, Karnataka 560017 https://lnkd.in/gKk48dh5 Date - 28-Jun-2025 ( 2 PM ) - Saturday Roles and Responsibility Manage and process accounts receivable transactions with high accuracy and attention to detail. Develop and implement effective strategies to improve cash flow and reduce outstanding balances. Collaborate with cross-functional teams to resolve billing discrepancies and ensure timely payments. Analyze and report on key performance indicators, such as delinquency rates and credit utilization. Identify and mitigate potential risks associated with accounts receivable, including bad debt and denials. Provide exceptional customer service by responding promptly to customer inquiries and resolving issues professionally. Job Strong knowledge of accounting principles, financial regulations, and industry standards. Excellent analytical, problem-solving, and communication skills. Ability to work effectively in a fast-paced environment with multiple priorities and deadlines. Proficiency in CRM software and Microsoft Office applications. Strong attention to detail and ability to maintain accurate records. Experience working in a BPO or IT-enabled services environment is preferred.

Voice hiring for AR calling and health insurance International Voice. Location :- Bangalore Shift :- US shift (Rotational) Pick and drop available, Food available. We are seeking a Patient Support Service Representative (Voice) to handle customer queries and provide assistance related to healthcare services. The role requires eective communication skills, attention to detail, and the ability to work in a fast- paced environment. What job duties can I expect to perform as a Customer Support Representative? Handle inbound and outbound calls related to healthcare services. Service customers seeking support with their monthly healthy benet package. This monthly benet can be used in pharmacies and is present on a card to be used for over-the-counter medications such as cold/u and nutritional supplements. Customers will seek help with replacement cards, balance checks, and contact information updates. Successful associates can distinguish varying levels of customer complexity & communicate Ensure compliance with HIPAA and other healthcare regulations. Resolve customer queries efiiciently while maintaining professionalism. Maintain records of patient interactions and escalate complex cases when needed. Bachelor's degree in any field Strong verbal and written communication skills. Ability to handle customer inquiries with empathy and professionalism. Basic knowledge of healthcare processes and medical terminologies (preferred). Problem-solving and multitasking abilities.

Prepare ILAs, Final Survey Reports, and requirement letters. Maintain records of claim intimation, surveyor visits, document status, and report. Follow up with insured and internal teams to minimize TAT Update data in CMS software Health insurance Provident fund

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 Outsourcing (BPO) team has implemented the processes and technologies for our clients bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction.Positions General Duties and Tasks:NTT are getting into contract with Client to manage End to End Health Claims Administration services. Our NTT Business Process Outsourcing (BPO) team has implemented the processes and technologies for our clients bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction. Requirements for this role include: Must have strong Health Claims End to End Domain Knowledge. Must have 8+ years experience in Claims Adjudication Minimum 2+ years as Team lead/Asst.Manager Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Ability to work independently; strong analytic skills. Detail-oriented, ability to organize and multi-task. Ability to make decisions. Required computer skills: Must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment.Problem SolvingReviews structured problems.Selects and applies appropriate standards/guidelines.Probes beyond the stated situation.Identifies underlying issues and consider possible alternatives. Job Duty Differentiators: Supervises processes and/or claims processing teams ensuring highest quality of service is provided. Includes the distribution of work, calculation and communication of productivity and quality results and review of audit appeals. Monitors production goals of team and reports results and issues to higher-level leadership. Assists team with escalated claims processing issues. **Required schedule availability for this position is Monday-Friday 6PM/4AM IST The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Description: JD for Investigations Manager, Claims Job Position Manager, Investigation - Claims based out of Corporate Office, Mumbai Job Brief Manager to oversee investigations for claims (Legal-TP Claims/ WC claims/ OD claims, PA Claims, Theft Claims & Health Claims, Commercial claims) of our GI business. The successful candidate will effectively ensure investigation conformity and minimize probability of exposure Academic Qualification Must be a graduate from a recognized institution or university. Law Graduate (LLB or LLM) + III pass out will be the first choice Required Experience / Key responsibilities Candidate must be experienced with 5 to 7 yrs in General Insurance Industry - specially in claims investigation field Experience in handling team (minimum 02 member) with minimum exposure of Zonal portfolio Exposure in dealing with MACT / Third Party Claims & WC matters, PA claims, Health claims, OD claims & Theft Claims investigation Candidate must have good drafting skills as well as communication skills Candidate must have well experience in recovery procedure (Pay & Recovery Legal Claims & Theft vehicle recovery) Experience in handling for & against litigations before various courts arising out of claims (civil, criminal etc..) Candidate should have well conversant about latest laws pertaining to Insurance Laws, Criminal law & Indian Evidence Act Experience in handling Advocates & Investigators : (1) Vetting of relevant applications whenever requires in best interest of the company (2) review of investigation report to conclude/ quantify cases into respective categories (settleable/contest/defence) Must be conversant with MS office for day-to-day activities & maintaining required MIS to extract important/effective details Experience in adducing evidence to defend the matters rigorously & to safeguard company's interest whenever required Experience in handling Criminal proceedings before Police authority or action required before RTO authority or subsequent authority whenever required

Manage insurer & client coordination, handle policies, endorsements, and claims, resolve escalations, build strong broker/client relations, lead servicing team, ensure seamless delivery & represent company in insurer meetings. Provident fund

Skill required: Claims Appeals - Claims Administration Designation: Health Admin Services 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 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.Includes the administration of health, life, and property & causality claims. Includes activities involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation. What are we looking for Healthcare ManagementCommitment to qualityAbility to work well in a teamAdaptable and flexibleWritten and verbal communicationProcess-orientationHealth 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

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. Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive If interested kindly share your resume to recruitment1@mdindia.com

Role & responsibilities Tariff Negotiations and cost management Conducting surprise audits and checks of the claims and case to case negotiations Manage workload of both field and office effectively Experience in dealing with providers (Hospitals/Diagnostics & OPD Clinics) Understanding of Health Claims and claim related processes Good understanding of Health Insurance and related products Managing relationship with the providers Flexible to travel across locations based on the organizational requirements Managing internal (Claims Team, Sales and Central Teams and external stakeholders (Brokers, Channel partners & Corporates) Managing and controlling of cost for the portfolio assigned Timely reporting of business MIS and reports to leadership team Analytical and data-driven approach in day to day work Lead and manage the technology & process related initiatives Complying to the audit and compliance related concerns as per organization guidelines Preferred candidate profile We are looking for a doctor profile with relevant experience in claims and willing to travel across AP & Telangana states. Ability to collaborate with various cross functional stakeholders and drive the agenda for closure Should have a good analytical mind to understand costs associated with hospital tariffs and claim cost and manage them effectively. Should have excellent communication, presentation and detailed oriented skills (MS Excel, PowerPoint)

1. Looking after the corporate client & their empanelment’s 2. Preparing bills of TPA, ESIC, ECHS, CGHS and other Private clients Independently. 3. Handling all queries related to patients. Call me on +91 97739 85718

Job Description 1 Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 2 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit 3 Candidate must have excellent knowledge of health insurance / Health TPA domain. 4 Candidate must have excellent bill/medical negotiation skills & customer handling skills. 5 Good communication skills in Hindi/English and regional language of the state/region. 6 Ready to relocate himself/herself at location within India as may be required according to the job requirement 7 Candidate must own vehicle to travel in various hospital assigned to him 8 Candidate must be computer literate and shall possess skills including but not limited to Microsoft Office Suite and navigating through internet Portals 9 Candidate will be mapped with minimum 20 hospitals for physical visit based on the location and city. Additionally 20-25 Hospitals for Case Audit and Management 10 Proficient in handling complex situations and customers. 11 Candidate must possess clinical knowledge for evaluation of medical files 12 Sound knowledge of surgical procedures and disease cure management

Role Description: As a Revenue Cycle Management (RCM) Associate / Senior Associate at PDA E-Services Pvt Ltd , you will be an integral part of our US healthcare operations team, responsible for managing the end-to-end revenue cycle process for dental practices in the United States. Your primary focus will be to ensure accurate billing, efficient payment processing, timely insurance follow-ups, and effective resolution of revenue-related discrepancies. Company Profile: PDA E-Services Pvt Ltd is a dynamic and fast-growing Global Capability Centre (GCC) for Piccadilly Dental Alliance (PDA) , a leading dental healthcare organization in the United States. Established in 2022 , we provide operational, administrative, and practice management support to US-based dental practices, enabling them to focus on delivering exceptional patient care. As PDAs exclusive India-based outsourcing partner, we are expanding rapidly with a strong emphasis on operational excellence and healthcare service expertise. Roles & Responsibilities: Ensure accurate and timely generation of patient bills. Support insurance-related pre-processing and post-processing requirements. Conduct payment reconciliation processes to ensure completeness of receivables. Identify and resolve billing and audit issues related to the US dental healthcare system. Analyse revenue trends and claims performance for efficient payment processing and insurance follow-ups. Demonstrate an end-to-end understanding of the US dental insurance clearance and claim management process. Maintain high attention to detail, strong organizational skills, and effective coordination and communication abilities. Regularly interact with the senior leadership team based in the United States for operational updates and issue resolutions. Qualifications: Education: Graduate in any discipline (B.Com / BBA / B.Sc / B.A / or equivalent preferred). Experience: Associate: 0-2 years of experience in RCM / medical billing / US healthcare process. Senior Associate: 2- 4 years of relevant RCM or US healthcare billing experience preferred. Strong verbal and written communication skills in English. Proficiency in Microsoft Office applications (especially Excel and Outlook). Good analytical and problem-solving abilities. Prior experience in US dental or healthcare RCM processes is an added advantage. Benefits Offered: Fixed weekend off (Saturday & Sunday) Opportunity to work with an expanding US healthcare organization. Professional growth and internal career advancement opportunities. Exposure to international healthcare operations and leadership interaction. Comfortable, collaborative, and inclusive work environment. Paid leaves and holiday benefits as per company policy. Job Details: Job Title: Associate / Senior Associate RCM Working Days: Monday to Friday (Saturday and Sunday fixed off) Location: PDA E-Services Pvt Ltd 405, Fourth Floor, PT Gera Centre, Dhole Patil Road, Bund Garden Road, Pune 411001.