272 Health Claims Jobs - Page 7

Resolve customer queries over calls, chat Address and resolve customer complaint or issues related to healthcare services, ensuring a positive and satisfactory experience Inform customers about health plans, insurance coverage, and healthcare service Required Candidate profile Excellent communication skills in English Only B.Pharma/ M.Pharma/ D.Pharma passed Freshers or Experienced can apply Strong understanding of medical terminology Immediate Joiners Rotational shifts Perks and benefits Incentives Health Insurance

# 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

Skill required: HM- Utilization Management - Healthcare Management Designation: Customer Service 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.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 flexibleCommitment to qualityProcess-orientationWritten and verbal communicationHealth Insurance Portability & Accountability Act (HIPAA) Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Hurry up Authentic Healthcare is hiring Medical officers Non clinical job AT Noida, HYD , Bangalore Location Role/Position: Permanent Experience: 1 to 2 yrs in TPA or clinical Education: BPT, MPT,BDS, BAMS, BHMS Shifts: Day shift work from office

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. Address - MD India Health Insurance TPA Pvt. Ltd. H.No.6-3-883/A/1 #: 201, 2nd Floor, imperial Plaza, Beside Topaz Building, Panjgutta, Hyderabad - 500082. Contact Number - 7030949730 ( Neha Nanoti )

Job description We Are Hiring for International Semi voice Process Profile -: Claim Processing associate ( Semi voice) Languages req: Excellent English communication Requirement -: Good Communication Skills Exp-: 6m- 5 yrs in claims Shifts:Rotational Location : Bangalore Immediate joiners only *** Only 2 rounds of interview Job description Document claim file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate. exposure and complexity for Property and Content damage and Liability/Injury claims. Exercise judgement to determine policy verification and coverage determination by analysing applicable coverage for claims and determining whether the loss falls within the coverage. Exercise judgement to determine liability by gathering and analysing relevant facts, images; utilizing applicable coverages. Identify anomalies and patterns to identify fraudulent claims and refer to SIU team based on SOPs Work to have a timely resolution to claims with complete ownership from initiation/intake to settlement. Assess damages by calculating applicable damage or range of damages. Negotiate settlement of a claim by establishing the appropriate negotiation strategy and utilizing available resources within authority limits. Meet quality standards by following best practices Responsible for data integrity and the appropriate documentation of the claim file as well as for compliance with regulatory requirements. Accountability in customer satisfaction and execute on the strategy to provide the best claims service for host damage protection. Ensure customer service by proactively communicating information, responding to inquiries, following customer protocols and special handling instructions. Ensure legal compliance by following federal laws and regulations, and internal control requirements. Key skills required: Bachelor's degree or college Diploma. • Experience in P&C, Healthcare Claims dealing with damage, liability or injury claims. • Good knowledge of Insurance claims end-to-end value chain activities, challenges and best practices. • Good knowledge of how to evaluate injuries and damage using market tools and technology. •General knowledge of the coverages available under the damage protection, liability policy and some common exclusions. • Results driven, ability to multi-task, pay attention to detail and follow procedures. Proven leadership and time management skills in a team environment. Job Type: Full-time Qualification :Any graduates (Note: All the rounds are Held through telephonic) Email : careers@glympsehr.com NOTE: - Please call or whatsapp Manya @ 9606553811 / 9606557106 !!!Thanks & Regards HR TEAM!!!

Job Summary: We are looking for a dynamic and experienced Manager Employee Benefits to join our team in Bangalore. The ideal candidate will have strong experience in employee benefits program management, relationship management, data analytics, and coordination with insurers and TPAs. Prior experience in a brokerage firm will be an added advantage. Key Responsibilities: 1. Client Relationship & Account Management: Act as the primary point of contact for assigned corporate clients. Build and maintain strong relationships with HR and employee stakeholders. Conduct regular review meetings with clients to understand needs, resolve issues, and offer strategic advice. Support renewals and policy upgrades through proactive communication and data insights. 2. Employee Communication & Support: Address employee queries and provide resolution related to group insurance policies, claims, endorsements, and benefit structure. Conduct employee awareness sessions on policies and claims processes. Manage escalations effectively and ensure timely resolution. 3. Insurance Operations & Coordination: Liaise with insurers and TPAs for smooth issuance, endorsements, claims processing, and reconciliation. Ensure timely policy endorsements, addition/deletion of members, and coverage changes. Track claims and coordinate for claim settlements and documentation. 4. Data Management & Reporting: Prepare and manage CD (Claim Details) statements, endorsement summaries, claim trackers, and MIS reports. Create and maintain dashboards for internal and client reporting. Analyze data to identify trends and provide actionable insights. 5. Internal Coordination & Compliance: Coordinate with internal teams for data collection, report generation, and service delivery. Ensure all processes comply with IRDAI regulations and internal quality standards. Qualifications & Skills: Graduate/post-graduate in any discipline (MBA/PGDM preferred). 5-7 years of experience in employee benefits management, with at least 2-3 years in an insurance brokerage setup. Strong understanding of group health insurance, claims process, and TPA functioning. Proficiency in MS Excel, PowerPoint, and dashboard tools. Excellent communication, interpersonal, and problem-solving skills. Ability to handle data-driven discussions with HR and insurance partners.

Role & responsibilities - Due Diligence - Document Indexing & Management - Sanction Screening - Compliance checks - Premium Bordereaux Processing - Knowledge of insurance systems like Acturis, Applied Epic/Eclipse will be added advantage - Experience in the insurance sector, preferably with brokers or MGAs, will be an added advantage - Familiarity with Lloyds systems integration (XIS, XCS, ICOS/IPOS) is a plus - Updating the process documents - Providing supporting documents during various internal/external audits - Advance excel knowledge Preferred candidate profile Need Fresher or who have experience into claims and settlement Must be fluent with communication

UK Health Care Process Nature of Work : Claim Processing/ Backend Candidates should have their own system and internet connection Configuration required Windows 10 Processor - i3/i5 RAM - 4 GB Speed - 10mbps rotational shifts, 5 days working Required Candidate profile Rounds of Interviews - HR - Medical Test - Email Test - Amcat - Ops

International Process Associate - US Healthcare Process Company Name - Sun Knowledge Inc. (KPO) About Company - We are into Healthcare medical billing. No SALES/MARKETING involved. Interview Reference Code - HR Sara - 6292238499 - (WhatsApp) Interview Date Starts From : 20th June 2025. Dress Code - Formals/ Smart Casuals Carry your hard copy CV and Aadhar Xerox should be attached to it Roles and Responsibilities 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 organized 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 Minimum Age Limit: 18 Years Maximum Age Limit : 35years . FRESHERS AND EXPERIENCE BOTH CAN APPLY. Perks and Benefits * Competitive salary: *15,000 to * 22,000 gross per month (based on experience) * Fixed weekends off on Saturday and Sunday * No sales pressure or targets * PF (Provident Fund) and ESI (Employee State Insurance) benefits * Attendance bonus: 1,000 per month for perfect attendance * Annual bonus: up to 15,000 *Cab Allowance INTERVIEW ADDRESS - Omega Tower, Bengal Intelligent Park, 11th Floor GP Block, Sector V, Bidhannagar, Kolkata, West Bengal 700091 Landmark - Near RDB Cinema ( SDF Bus Stop, Salt Lake ) Walk-Interview Date: 20th June 2025, 11am to 2:00pm Onwards. Reference Code - HR Sara Yasmin on top of their CV- 6292238499

Responsibilities: * Lead claims settlements and operations on-site * Ensure compliance with HIPAA & insurance ops standards * Manage health claims of our patients from start to finish * Collaborate with stakeholders on claim resolution

Role & responsibilities Basic requirement Basic understanding of Microsoft applications (Excel, Word, etc.). Preferably, a basic understanding of health insurance. Good communication skills in Marathi, Hindi, and English. Flexibility to work in shifts. Preferred Skills: Familiarity with insurance policies and procedures related to claims. Previous work experience in health claims or investigation departments. Experience in using Microsoft applications for data analysis and reporting.

Role & responsibilities To process transactions in line with the defined process on simple/medium/high complex tasks and achieve operational goals and standards as defined by the organisation. Complete the action required on the demand within the required TAT ensuring the required level of accuracy & compliance requirements

We are Conducting Mega Job fair for Top 10 Companies for AR calling. Chennai, Noida, Bangalore & Hyderbad. Job Title: AR Caller (Accounts Receivable Caller) Department: Revenue Cycle Management / Medical Billing Location: Bangalore / Hyderabad / Chennai / Noida Job Type: Full-Time. Experience: 0 to 10 years Job Summary: We are seeking an AR Caller to follow up on outstanding insurance claims and ensure timely reimbursement. The ideal candidate will be responsible for calling insurance companies (payers) to verify claim status, resolve denials, and secure payment for services rendered. Key Responsibilities: Call insurance companies and follow up on pending claims. Understand and interpret Explanation of Benefits (EOB) and denial codes. Identify reasons for claim denials or delays and take appropriate actions. Resubmit claims or file appeals when necessary. Document all call-related information accurately and clearly. Work with billing teams to resolve billing issues. Meet daily productivity and quality targets. Stay updated on payer policies and healthcare regulations. Required Skills: Excellent communication skills (verbal and written) in English. Basic knowledge of the US healthcare system and insurance claim process. Attention to detail and analytical thinking. Familiarity with denial management and RCM workflow is a plus. Experience using billing software like Athena, NextGen, eClinicalWorks, or similar is a bonus. Qualifications: Bachelors degree preferred, but not mandatory. Prior experience in AR calling/medical billing is an advantage. Willingness to work night shifts (for US clients). contact Hiring Manager : Mallik - 9900024951 / 7259027282 / 7259027295 / 7760984460.

Key Responsibilities: Process and analyze medical claims from US healthcare providers and insurance companies. Understand various insurance policies, terminologies, and healthcare workflows (training provided). Handle denials, rejections, and resubmissions as per payer requirements. Ensure accuracy in data entry and maintain quality standards. Communicate effectively with team leads and follow-up on claim status or escalations. Maintain confidentiality and HIPAA compliance standards. Meet daily/weekly targets and productivity goals. Requirements: Bachelors Degree (Only – BCom, BBA, BA, BCA, are eligible to apply) Excellent written and verbal communication skills in English. Basic knowledge of MS Office and computer systems. Willingness to work in night shifts (US business hours). Strong attention to detail and problem-solving ability. Ability to work independently and as part of a team.

Process cashless and reimbursment claims (Should have knowledge of processing retail policies of National/United/New India/Oriental insurance companies.

Role & responsibilities Ensure team members are visiting the customers place as per the schedule Monitor the team members activity in terms of volumes (documents collected) Review the queries received from the customer and the responses from the team members Help team members in resolving escalationsfrom customers Review the reports sent by the team members and take necessary actions (issues with respect to claim registrations) based on the report. Coordinate with front end team and help in getting the claims registered Conduct weekly/monthly one on one review with the team membersto understand their concerns and help simplify the process Review the claims dump along with front end team and take necessary action for IR raised, reopening the claims, dummy claims as appropriate Review the feedback received from the customers. Rework on the low ratings and identify the areas of improvement and implement process improvements Team management Review on the low C-SAT/D-SAT to improve the communication quality or process gap if any as per the clients understanding/requirement. Coordinate with internal/external stakeholders and other regions on the support needed for the client requirements, like helpdesk , wellness-related activity and more. Preferred candidate profile 3-5 years of experience in people management and customer service & 7-8 years of overall experience in service industry

Job Title: Insurance Desk Executive TPA Coordination / Claims Specialist Location Options: KIMS Hospital, Nashik Survey No. 571/1A/1, Plot No. 63, Mumbai Agra Highway, Nashik, Maharashtra – 422001 KIMS Hospital, Thane West – Queens St, near Brentford Cooperative Society, Hiranandani Estate, Thane West, Maharashtra – 400615 Organization: Ayu Health Hospitals Experience Required: 0–2 years (Freshers are welcome to apply) Preferred Gender: Male Candidates Preferred Location: Candidates residing near hospital locations will be given preference About Ayu Health: Ayu Health is one of India’s fastest-growing healthcare networks, dedicated to making high-quality healthcare accessible and affordable for all. With a focus on technology-driven solutions, Ayu Health partners with reputed hospitals and clinics across the country to deliver standardized care, transparent pricing, and a seamless patient experience. We are on a mission to build India’s most trusted healthcare brand. Key Responsibilities: Handle insurance/TPA desk operations at the hospital premises Coordinate with TPA and insurance representatives for claim submission and follow-up Manage and organize patient insurance documentation accurately Track approvals, follow up on pending claims, and address rejections effectively Communicate professionally with patients, hospital staff, and insurance partners Support hospital administrative needs and maintain documentation records Multi-task and work collaboratively within the hospital environment Candidate Requirements: 0–2 years of experience in TPA coordination, insurance desk, or claims processing in hospitals (Freshers with good communication skills can apply) Strong interpersonal and communication skills Basic understanding of hospital processes is a plus Ability to manage documents and work efficiently under pressure Must be reliable, punctual, and a team player Preference will be given to candidates living nearby the hospital location Male Candidates only Immediate Joiners will be preferred

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development and implementation of business plans and goals

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

SUTHERLAND IS HIRING- CLAIMS SPECIALIST Interested candidates can share your resume to lilly.prisicilla@sutherlandglobal.com POC: Lilly WANT A GOOD WORK LIFE BALANCE Fixed shifts and fixed weekend off Collection Voice Process Sutherland is seeking highly proficient * Claims associate in Bangalore. If you have the right experience and expertise, this could be an excellent career opportunity for you. Position Details : " Location: Kundan halli Bangalore Work Schedule: *FIXED SHIFTS AND FIXED Saturday & Sunday off* Compensation: Competitive salary with a significant hike on your last drawn salary, plus attractive incentives and transport allowance Work Mode: On-site Eligibility Criteria: Bachelors degree or college Diploma. Experience in P&C, Healthcare Claims dealing with damage, liability or injury claims. Good knowledge of Insurance claims end-to-end value chain activities, challenges and best practices. Good knowledge of how to evaluate injuries and damage using market tools and technology. General knowledge of the coverages available under the damage protection, liability policy and some common exclusions. Results driven, ability to multi-task, pay attention to detail and follow procedures. Proven leadership and time management skills in a team environment. Good writing, communication and presentation skills. Interested candidates can share your resume to lilly.prisicilla@sutherlandglobal.com POC : Lilly

Tele Callers – 05 Team Leader – 01 Compliance Officer – 01 knowledge of IRDA regulations insurance broking compliance Underwriter – 01 from the insurance industry Claims Executive – 01 Position relevant experience in insurance claims. Required Candidate profile JOB LOCATION WAGHOLI ,PUNE . TELECALLERS ,TEAM LEADER ,COMPLIANCE OFFICER ,UNDERWRITER ,CLAIMS EXECUTIVE ALL HAVING EXPERIENCE IN LIFE & HEALTH INSURANCE SECTOR EARLY JOINING NEEDED Perks and benefits PERKS & BENEFITS AS PER INDUSTRY STANDARDS

JOB DESIGNATION-Process Associate JOB LOCATION- Jaipur JOB DESCRIPTION- Checking Claim status/patient eligibility with Insurance companies in the USA over the phone. CANDIDATE REQUIREMENTS/QUALIFICATION/SKILLS Graduates in any Discipline (other than BTECH pursuing) Good Command over English (Oral & Written) Good Analytical Skills Computer Savvy Good Listening Skills Flexible to work in night Shifts BENEFITS 1. Salary - Best in Industry & Annual salary revision upon completion of 1 year. 2. Excellent learning platform with a great opportunity to build career in Medical Billing. 3. Quarterly Rewards & Recognition Program. 4. Performance-based monthly incentives. 4. Five days working : Monday - Friday (Sat & Sun Fixed week off) 5. Two-way cab facility. 6. Subsidized one-time meal. 7. Gym access to all the employees.

Please take some time to review the JD and the project information, as they will give you a deeper understanding of the role and responsibilities. If you have any questions or need further clarification, do not hesitate to reach out to us. We are here to provide you with all the support and information you need during this process. Client- Optum Position: Quality Analyst Location: Hyderabad Location: Optum Global Solutions, (Avans)Phoenix Info city Private Ltd, Site 4, 1st floor, SEZ, Hitec City, Hyderabad, 500081. Interview Process: Face to Face Contract base Job Payroll will be Joulestowatts Business Solutions experience: 6months to 3Year Location Hyderabad Work module Work from office Cab facility - Both way cab provided Notice period Immediate Nature of work: Non-Voice Amenities: Deployment at Client location Transportation – Home Pickup and Home Drop facility within transport radius. Pantry Services – Regular Tea, Green Tea, Coffee, Milk with Sugar/Jaggery available round the clock. Selection process: Candidates need to be available in Optum premises during the Interview process, no scope of virtual interview. 1st round – Typing Assessment (30 WPM, 95% accuracy) 2nd round – Written assessment (Analytical, Reasoning, US Healthcare) 3rd round – Line Manager Round 4th round – Final Round Need to carry pens along Need to be in formal attire Shift timings: 5:45 PM to 3:15 AM (Night shift) primarily, however they may be asked to work in morning shift as well on need basis. Hence candidates must be flexible to work in both the shifts. It’s the peak season. Hence candidates must be ready to work overtime on weekdays/weekends when required as CLRA guidelines. OTs are payable additionally. Role: Quality Analyst (Contractual/Temp – Would be converted purely based on performance) Salaries + Incentives: Package 2.4 LPA + Additional Incentives Incentives Rs.400 for 100% attendance (monthly) Rs.200 is allocated towards team outings and team refreshment activities (monthly) Top 10% of the performers would receive a GV worth Rs.1000 (monthly) Rs.400 per month towards Project retention bonus which would be accumulated and released along with FnF. Candidates serving the entire tenure of the program are eligible for it. If interested kindly share cv

Role & responsibilities Conduct regular audits of inbound calls and customer service emails to assess quality, accuracy, and adherence to standard operating procedures. Identify communication gaps, process deviations, and compliance breaches. Maintain detailed records of audit findings and share trend analysis reports weekly/monthly. Collaborate with team leads/managers to coach and guide staff on improving customer interactions. Assist in designing quality monitoring formats and audit checklists. Help develop training content and support refresher sessions based on audit insights. Recommend process and communication improvements based on audit observations. Ensure data privacy, accuracy, and confidentiality during audits Publish MIS and drive for better quality scores The candidate should have 1) Minimum of 3-4 Years in Call center Call handling & e-mail handling experience 2) Minimum 1year experience in auditing calls/e-mails and should have delivered feedback to the employees 3) Understanding the parameters like Quality Form creation/Coaching/Training Needs Identification (TNI) through audits