272 Health Claims Jobs - Page 5

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 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

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 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

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 customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skills. Written and verbal communication. Collaboration and interpersonal skills. Ability to meet deadlines. Process-orientation Roles and Responsibilities: 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

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 experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skillsWritten and verbal communicationCollaboration and interpersonal skillsAbility to meet deadlinesProcess-orientation 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

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 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 Ability to work well in a teamAdaptable and flexibleProcess-orientationWritten and verbal communicationCommitment to quality 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

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 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 Adaptable and flexibleProcess-orientationResults orientationWritten and verbal communicationCommitment to quality 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

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 skills Should be ready to work in night shifts during training time Experience Eligibility Criteria : Any graduates with IP DRG Experience (Min of 1+ years) Active credentials through CIC & CCS is mandatory Excellent verbal and written communication skills Should be ready to work in night shifts during training time Interested candidates can share resume - abdul.rahuman@cotiviti.com or contact the below number Regards, Abdul Rahuman | Sr HR Executive 9080276094

Wipro hiring for Insurance Back-office profile in Kolkata location. We are hiring Any Graduate fresher OR Experienced. Candidate must be comfortable with WORK FROM OFFICE. *Must BE* Gradutaion is Must The candidate must have good verbal communication skills. The candidate must be staying or ready to relocate to Kolkata. As it is WORK FROM OFFICE. Roles and Responsibilities Candidate will take care of Insurance claims of International customers. Desired Candidate Profile Any Grad fresher- 3.3 Lakhs Experienced- 3.3 Lakh + Inc.+ Cabs Other Benefits Fixed Shift time- US shifts Complete Inbound Voice Profile Cabs in odd hours only If you are meeting the above requirements. Then please please call our recruiter. Click on Apply NOW Tab Contact: Ravinder Singh Rawat

Wipro hiring for Insurance Back-office profile in Kolkata location. We are hiring Any Graduate fresher OR Experienced. Candidate must be comfortable with WORK FROM OFFICE. *Must BE* Gradutaion is Must The candidate must have good verbal communication skills. The candidate must be staying or ready to relocate to Kolkata. As it is WORK FROM OFFICE. Roles and Responsibilities Candidate will take care of Insurance claims of International customers. Desired Candidate Profile Any Grad fresher- 3 Lakhs Experienced- 3 Lakh + Inc.+ Cabs Other Benefits Fixed Shift time- 1:30 PM to 11 PM Complete Inbound Voice Profile Cabs in odd hours only If you are meeting the above requirements. Then please please call our recruiter. Click on Apply NOW Tab Contact: Ravinder Singh Rawat

Manager-Segment Incharge The role is responsible for all tasks related to Processing and Settlement of claims, Monitoring TPA performance for the assigned business. The role includes managing the assigned specialized business handling of any one or more of the following activities: Settlement of Claims, Monitoring TPA performance based on defined KPI, System, Development, UAT, Portfolio Analysis, MIS/Compliance. If this is you, we are looking for you! Key Responsibilities Managing end-to-end claims. Requisitioning detailed information on all reported and settled Claims and monitoring performance of TPAs, evaluating performance of all TPA based on parameters of SLA with Regular Review of defined KPIs. Monitoring and performance evaluation of TPA including timely review of TAT & quality for various process followed in TPAs, daily TAT monitoring, escalation & expectations management for specialized business handling of retail portfolio. Maintaining and updating TPA records on daily basis which help us to know the performance of retail policies and portfolio. Conducting QC of reports and data of TPA shared with us on regular intervals to analysis the data on all benefits as per retail policies. Supporting Actions IT Systems Development System development for uploading and extracting TPA claims and generating reports from the same. Cost containment without losing on customer experience, actionable of feedbacks on claims experience. Educational Qualification: - Preferably MBBS, BHMS, BAMS Doctor Minimum 7-9 years in handling similar role Experience in handling provider management (Hospitals and other vendors) is mandatary. Its a urgent opening please share your resume at aparna@aceconsultants.in

Role & responsibilities Processing of Claims Health files. Claim Registration and Claim Adjudication. Identifying the Fraud. Adhering to SLAs and processing the claims with in the TAT as per policy terms and conditions. Supporting CRM, provider, sales and grievance teams. Preferred candidate profile Pharm-D, BSc Nursing, B .Pharmacy, BDS Any Graduate with minimum 2+ years of Claims Health processing experience. Salary Budget - up to 4 lakhs. Job location Chennai Evaluation would be based on competency, age, experience, stability

Role & responsibilities Process cashless and reimbursment claims (Should have knowledge of processing retail policies of National/United/New India/Oriental insurance companies. Preferred candidate profile BAMS/BUMS/BHMS Fresher or max 2 years experience in the similar field. Ready to work in shifts

Job Description: Processing of Claims Health files. Claim Registration and Claim Adjudication. Identifying the Fraud. Adhering to SLAs and processing the claims with in the TAT as per policy terms and conditions. Supporting CRM, provider, sales and grievance teams. Eligibility Criteria: Pharm-D, BSc Nursing, B .Pharmacy freshers only(Qualified Graduates with all certificates in hand). Any Graduate with minimum 2+ years of Claims Health processing experience. Salary Budget - up to 4 lakhs. Job location Ameerpet, Hyderabad. Evaluation would be based on competency, age, experience, stability

Designation: Underwriter - Life insurance Experience: 2 to 8 years Job Location: Pune Qualifications/Requirements: Education: Bachelor's degree in homoeopathy, pharmacy, physiotherapy, dental and any equivalent medical degree. Experience: Should have experience in life insurance underwriting or a related field in US/European domain. Familiarity with life insurance products and policies. Good to have knowledge of life insurance terminologies. German language knowledge is an added benefit. Skills: Strong analytical and decision-making skills with attention to details. Excellent communication and interpersonal skills. Proficiency in underwriting software and Microsoft Office applications. Attention to Detail: High level of accuracy in reviewing applications and assessing risks. This role is essential in ensuring the financial stability of an insurance company by managing risk effectively and maintaining a balance between competitive pricing and risk exposure. Roles/Responsibilities: You will be responsible for evaluating and assessing the risks involved in insuring individuals for life insurance policies. The primary goal is to determine whether to approve or deny insurance applications, and to set appropriate premiums based on the risk assessment. Risk Assessment: Evaluate applications for life insurance policies. Analyze medical records, financial information and lifestyle factors. Assess the risk level of applicants to determine insurability. Decision Making: Approve or deny applications based on underwriting guidelines and risk assessment. Determine appropriate premium rates for approved policies. Communication: Communicate decisions to insurance agents and brokers. Explain underwriting decisions and provide guidance on policy options. Compliance: Ensure all underwriting activities comply with state and federal regulations. Stay updated on changes in insurance laws and regulations. Data Analysis: Utilize underwriting software and tools to analyze data effectively. Monitor trends and patterns to inform underwriting practices. Disclaimer: At Allianz, we believe in a diverse and inclusive workplace and in giving fair and equitable opportunities to all our employees, so everyone can succeed. We, the Allianz Services India family, welcome all applications from all regardless of gender identity and/or expression, sexual orientation, race or ethnicity, age, nationality, religion, disability, or philosophy of life.

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 to pass or clear the Health Insurance claims. Qualifications Bachelor's degree. Previous experience in TPA management or Banking. Good interpersonal and communication skills. Isha Thakur 9056448144 HRD

*2-4 years exp. in Indian Insurance end-to-end group medical claims, *Resolved queries via Freshchat/Freshdesk (Customer Support) *Policy Document assessments *Stakeholders Mgmt., Collaboration & led escalations *Email/WhatsApp comms. Required Candidate profile *2-4 years exp. in Indian Insurance claims processing, CRM/Servicing/Claims handler roles in Insurer /TPA. *Graduate in healthcare, insurance *Verbal proficiency in English & Hindi must.

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 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 Adaptable and flexibleCommitment to qualityProcess-orientationResults orientationWritten and verbal communication 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: 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 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 Adaptable and flexibleCommitment to qualityProcess-orientationWritten and verbal communicationResults orientation 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

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 - 07-July-2025 ( 2 PM ) - Monday 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.

Hiring Alert Medical Officer (Claims) | Contract Role Location: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Company: Medi Assist Insurance TPA Private Limited Timing: 9:30 AM 6:00 PM | MonFri (Rotational Saturdays working) Eligibility: BAMS or BHMS graduates only 03 years experience (freshers welcome!) Role Overview: You will scrutinize and process insurance claims based on policy terms, verify treatment/diagnosis, raise queries for incomplete documents, and ensure accurate and timely closure of claims. Key Skills: Strong medical understanding Basic computer & typing skills Good communication Send your resume to: kishan.dwivedi@mediassist.in

Responsibilities: * Manage health insurance claims from start to finish. * Ensure timely TAT compliance through process improvement. * Prepare medical summaries for cashless procedures.

Hiring Clinical Doctors for Medical coding role in Mohali !! Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT, MPT,BUMS 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. (CPC/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 rotational shift (Including night). Job Location - Mohali Interested candidates can share resume - karthickumar.sekar@cotiviti.com Regards, Karthick 8754142459

Consulting Skills, Client Knowledge, and Client Service: Prioritizes work as required to respond to client needs effectively UK pension/retirement/claims Healthcare / Customer support Participates & contributes in daily huddles and status meetings Required Candidate profile Excellent communication skills Excellent understanding of the organization's goals and objectives. Takes ownership and responsibility for work assigned.