272 Health Claims Jobs - Page 6

Job Description (IFD) Communicating with clients and understanding the investigation requirements. • Meeting with clients to discuss the nature of the investigation. • Conducting field investigations on appointed cases, insurance claims, or client requests. • Conducting in-depth research on various appointed cases. • Decide the extent and validity of a claim, and in so doing, prevent fraudulent claims by determining the claim's authenticity. • Gathering and analyzing evidence reports. • Conducting photographic and audio surveillance to gather evidence • Reviewing and solving cases by authenticating insurance claims. • Coordinating with agents to understand insurance claims matters. • Answering to specific trigger in reports. • Manage multiple cases with confidence and accuracy and respond well to working to meet targets and tight deadlines. • Prepare reports, maintain records and keep track of evidence trails. Note : Bike is Mandatory for travelling. Kindly share your Resume on ta4@mdindia.com

INTERNATIONAL VOICE PROCESS US HEALTHCARE Location: Airoli, Mumbai Shift: Rotational (Predominantly Night Shifts) Work Mode: Work from Office Joining: Immediate Batch Starts: 7th July Role Overview: Join a leading US Healthcare BPO as a Customer Support Associate and be part of a dynamic international voice process team. This is a great opportunity for fresh graduates to start their career in a fast-growing industry. Eligibility Criteria: Graduate Freshers with excellent English communication skills Not eligible: Technical or Hotel Management degrees Experience Advantage: BPO experience with complete documentation Full-time students / Out-of-boundary candidates Not eligible Compensation & Perks: In-hand Salary: 20,000/month Night Shift Allowance: 1,500 3,000/month Performance Incentives: 3,000 (Fresher) | 4,500 (Experienced 1+ year Intl Voice) Training Stipend: 5,000 during 10-day virtual training + 5,000 bonus post 30 days CTC: 2.4 – 3.0 LPA (based on experience) Transport: One-side cab (Night hours only: 7PM – 7AM) Working Structure: Days: 5 days/week Week Offs: 2 rotational (including split offs) Shift Type: Rotational, mostly night shifts Important Notes: Boundary conditions apply (Boundary list attached) No transportation during daytime Self-travel or out-of-boundary applicants won’t be considered Apply Now and kickstart your career in the growing US Healthcare industry ! Interested candidates are kindly requested to share their CV or reach out to our HR team directly: Rohit : 8630717558

TATA AIG General Insurance Company Limited is looking for Senior Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Analysis for the current business practice. Find out the different operational strategies. Work on developing the current operational strategy applied to the company with the most recent technology. Coordinate with the operations manager to take the required steps after brainstorming and research. Optimize the operations in the company. Put the suitable operational strategy to fit with the companys culture. Implement the operational strategy in the different departments of the company. Supervise the strategy, and make sure that all the employees respect this strategy. Work regularly in improving the companys operations performance. Also, the deputy operations manager works in certain cases in touch with the clients to make sure that they receive the required service with the highest quality. In Customer service company, the deputy operations manager works with his team to make the clients satisfied by offering to his team the required training and courses to be able to communicate correctly with the customers. Follow up with the running project daily in order to make sure that they follow the right operation process. Check the logistics operations. Monitor t Show to the employees the company strategies and regulations in order to maintain the operation process. Solve all the different problems that could face the operations, to ensure the operational strategy. Issue a weekly, and monthly report for the operations manager to see all the updates realized on

MANDATORY LANGUAGES: Kannada, Tamil , Telgu, Malayalam Roles and Responsibilities: Provide health coaching services to patients, focusing on patient care and counseling. Assist doctors in managing patient relationships and ensuring effective communication between patients, families, and medical professionals. Support healthcare operations by coordinating with various departments to ensure seamless delivery of healthcare services. Collaborate with health management teams to develop strategies for improving patient outcomes through data-driven decision making To schedule your interview Call or send your CV through WhatsApp (number mentioned below) HR Saumya: 8263043709

Responsibilities: * Ensure accurate Hospital Billing of cash/insurance patients. * Manage TPA claims from submission to settlement * Collaborate with insurance companies on claim resolution and settlement. Please contact 9326009595

International Process Associate - US Healthcare Process - Night Shift Company Name - Sun Knowledge Inc (KPO) About Company - We are into Healthcare medical billing. No SALES/MARKETING involved. Interview Reference Code - " HR Sanskrity " - 9046450266 - WhatsApp/Call. Applicants need to write "HR SANSKRITY" on the top of their Resume/CV. Dress Code: Formals/ Smart Casuals Documents to Carry: your hard copy CV and Aadhaar Xerox should be attached to it. Roles and Responsibilities: This is the US Healthcare process. Candidates have to resolve queries and issues of Doctors and hospitals regarding medical Billing and Insurances. Desired Candidate Profile : Must have Excellent Communication in English . (Both Oral and Written) Should Have Good Interpersonal & Analytical Skills. Must be well organised and detail-oriented . Knowledge in MS Office and Good typing Speed . Willingness to work for US Shift ( Night Shift ) Work from Office only. Minimum Qualification - Undergraduate . Only Immediate Joiner required Age Limit Up to 35 years old. FRESHERS AND EXPERIENCE BOTH CAN APPLY. Candidates from B.Sc and Pharma background are preffered. Perks and Benefits : Gross Salary 15 k to 22 k Attendance Bonus - 1000 Statutory Bonus - 15000 CAB Facilities or transportation reimbursement of 1800 5 days in a week ( Monday To Friday working ) Saturday and Sunday Fixed off.

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 Healthcare Utilization ManagementAbility to work well in a teamAdaptable and flexibleProcess-orientationWritten and verbal communicationCommitment to qualityHealth 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

We are looking for a highly skilled and experienced AR Associate to join our team at Omega Healthcare Management Services Pvt. Ltd., BE, B.TEC, & Master Please ignore Location - Omega Healthcare - F2 Airport Bengaluru, Karnataka Rustam Bagh Layout, Bengaluru, Karnataka 560017 https://lnkd.in/gKk48dh5 Date - 28-Jun-2025 ( 10.30 AM -1.30 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.

Roles and Responsibilities Review medical records, including doctor's notes, test results, and other relevant documents to determine long-term disability claims. Desired Candidate Profile 2-7 years of experience in Health Claims or related field (Medical Summarization). Strong understanding of long-term disability claims process. Excellent communication skills for effective collaboration with healthcare providers. Ability to work independently with minimal supervision while maintaining high accuracy standards.

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Looking for voice process only. Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : kowsalya.k HR (8122343331)

GOOD KNOWLEDGE IN INSURANCE ,CASHLESS PROCESS INTO HOSPITAL

To be liaison between the patient, the hospital, and TPA, managing claim processing by coordinating with the TPA to facilitate timely claim settlements and patient billing, all while adhering to insurance guidelines and regulations.

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.

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 Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Preferences for this role include: 1.5+ 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. 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. Both Under Graduates and Postgraduates 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.

Long Term Disability Claim Manager Role Overview: The LTD Claim Manager will manage an assigned caseload of Long Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners in order to gather the information that is most relevant to each claim. It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate customer eligibility and interact with internal and external customers including, but not limited to, customers, employers, physicians, internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim. What You'll Do: Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach. Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information Execute on all client performance guarantees Respond to all communications within customer service protocols in a clear, concise and timely manner Make fair, accurate, timely, and quality claim decisions Adhere to standard timeframes for processing mail, tasks and outliers Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.) Clearly articulate claim decisions both verbally and in written communications Understand Corporate Compliance, Policies and Procedures and best practices Stay abreast of ongoing trainings associated with role and business unit objectives What You'll Bring: High School Diploma or GED required. Bachelor's degree strongly preferred. Long Term Disability Claims experience preferred. Experience in hospital administration, medical office management, financial services and/ or business operations is a (+) Comfortable talking with customers and having thorough phone conversations. Excellent organizational and time management skills. Strong critical thinker. Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously. Ability to focus and excel at quality production Proficiency with MS Office applications is required (Word, Outlook, Excel). Strong written and verbal skills demonstrated in previous work experience. Specific experience with collaborative negotiations. Proven skills in positive and effective interaction with customers. Experience in effectively meeting/exceeding personal professional expectations and team goals. Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset. Comfortable giving and receiving feedback. Flexible to change. Demonstrated analytical and math skills. Critical Competencies: Decision Quality Communicate Effectively Action Oriented Manages Ambiguity Customer Focus

Interested Candidates may connect with Ms.Zoya Shamsi +91 7251000195 (11am-5pm) About the Role: We are seeking a highly motivated and experienced individual with a medical background to join our dynamic team as a Medical Claims Call Center Representative. In this role, you will be the frontline of our customer service, handling inbound calls related to medical claims and rejections. Your primary focus will be to provide exceptional customer service while resolving inquiries and concerns effectively, ensuring a positive experience for every Niva Bupa member. Key Responsibilities: Answer incoming customer calls promptly and professionally. Assist customers with navigating medical claims, including inquiries about submissions, rejections, and procedures. Provide accurate and detailed information about claim processes, documentation requirements, and insurance coverage. Investigate and resolve customer concerns with a focus on high satisfaction and clear communication. Collaborate with internal departments like claims processing to address complex issues and expedite resolutions. Maintain extensive knowledge of Niva Bupa products, medical billing codes, and claim procedures. Document customer interactions and update records accurately in our system. Identify and escalate critical or unresolved issues to the appropriate supervisor. Adhere to company policies, procedures, and compliance guidelines. Key Requirements: Education & Certificates: B.Pharm & M.Pharm. Minimum 1-3 years of call center experience, preferably in healthcare or medical insurance. Strong knowledge of medical terminology, insurance claim procedures, and billing codes. 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 computer systems, including CRM software and Microsoft Office Suite. Ability to work effectively in a team-oriented environment. Flexibility to work various shifts as per business requirements. What you'll gain? A competitive salary package of up to Rs. 3.5 LPA, based on your experience and Interview performance. Be part of a growing and respected healthcare company. Make a real difference in the lives of our members by providing exceptional customer service. Work in a dynamic and supportive environment with opportunities for growth and development. Competitive salary and benefits package. Ready to join Niva Bupa and contribute to a team dedicated to improving lives? Apply today!

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Looking for voice process only. Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : Lithan Kumar HR (7339696444) Those who have experience in Non voice please don"t apply

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : Varsha HR (8056370297) Those who have experience in Non voice please don"t apply

# 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

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. Astha Saklani 7087994355 HRD

Role & responsibilities A key member of Customer Service Operations team, responsible for providing an efficient, effective and compliant service to policyholders. Key accountabilities include handling of simple and complex cases, quality in service delivery, accuracy in providing and capturing information while adhering to compliance guidelines and support to team managers. Preferred candidate profile Good verbal and written communication skills Freshers eligible ; Preference would be given to individuals from an insurance background with approximately 1 years experience (Insurance Associate) with experience in handling written communication Perks and benefits Hybrid working mode - 3 days in office

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 Healthcare Utilization ManagementAdaptable and flexibleAbility to work well in a teamCommitment to qualityWritten 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

Skill required: Claims Services - Payer Claims Processing 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.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 Us shiftsQuick learner 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

Key Responsibilities: Handle end-to-end reimbursement and cashless claims for corporate clients' employees and dependents. Scrutinize claim documents for completeness, medical validity, and compliance with policy terms. Coordinate with empaneled hospitals, insured members, and insurance companies for claim clarification, queries, and approvals. Maintain TAT and SLA commitments for smooth and timely processing. Ensure compliance with IRDAI guidelines and internal company SOPs. Update and manage claims data in the internal system accurately. Prepare and share MIS reports with internal stakeholders and corporate clients. Manage escalated and high-value claims with detailed attention and resolution

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