619 Insurance Claims Jobs - Page 6

Job Description: 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

Greetings from ReSource Pro! Job Title: Analyst, Service Delivey Working Experience: 2 - 7 years Department: US Property and Casualty (P&C) Insurance Minimum Qualifications: Any Graduation Purpose of the Position: Join our dynamic team at ReSource Pro India and elevate your career in the US Property and Casualty (P&C) Insurance sector. We are seeking passionate professionals to contribute to our innovative and forward-thinking environment. Key Responsibilities: Insurance Expertise: Mastery in Rating/Online Rating, Quoting, Submissions, and Endorsement tasks. Industry Knowledge: In-depth understanding of Lines of Business (LOBs) such as Workers Compensation, Business Owners Policies, General Liability, BOP, etc. Technical Skills: Advanced skills in MS Excel. Communication: Strong communication abilities to effectively collaborate and drive results. Why Choose Us? Innovative Environment: Be part of a team that values creativity and innovation. Career Growth: Enjoy numerous opportunities for professional development and advancement. Collaborative Culture: Thrive in a supportive and team-oriented workplace. Ready to Make an Impact? If your skills match our needs, we would love to connect with you! Contact Scope: Send your resume to Sakshi Gupta at sakshi_gupta@resourcepro.in.

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.

We are hiring for a Senior Process Associate in Insurance Claims with 37 years of relevant experience. This is an excellent opportunity to join a reputed financial services firm and play a key role in managing claims, ensuring operational accuracy, and supporting risk management initiatives. Your Future Employer - A globally respected organization in the financial services space, known for its strong commitment to process excellence, innovation, and employee growth. Responsibilities - Manage end-to-end claims processes within the insurance domain Demonstrate strong understanding of banking and insurance services Communicate clearly and effectively with internal and external stakeholders Perform risk management activities and support insurance programs Execute reconciliation tasks and ensure accurate documentation Prioritize tasks and meet deadlines in a fast-paced environment Collaborate with product and process experts to stay updated on workflows Requirements - 3-7 years of relevant experience in insurance claims Any graduate (Finance qualification preferred) Excellent written and verbal communication skills Proficiency in Microsoft Excel Comfortable working in a 6 PM - 3 AM shift (Hybrid work model, Pune) What is in it for you - A hybrid work environment providing flexibility and structure Opportunity to be a part of a high-performing, growth-focused team Exposure to end-to-end insurance operations with a global client base Continuous learning and career advancement in a leading firm Reach us: If you think this role aligns with your career aspirations, kindly send your updated CV to vasu.joshi@crescendogroup.in for a confidential discussion on the opportunity. Disclaimer: Crescendo Global specializes in Senior to C-level niche recruitment. We are passionate about empowering job seekers and employers with an engaging, memorable job search and leadership hiring experience. Crescendo Global does not discriminate based on race, religion, color, origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Note: Due to the high volume of applications, if you do not hear back within 1 week, please assume your profile was not shortlisted. Your patience is appreciated. Scam Alert: Crescendo Global never asks for money, purchases, or system upgrades. Verify all opportunities at www.crescendo-global.com and report any fraud immediately. Stay alert! Profile Keywords - Claims Management Jobs, Insurance Jobs, Finance Operations, Reconciliation, Claims Analyst, Risk Management, Hybrid Jobs Pune, Excel Insurance Jobs, SPA Jobs Pune, Insurance Claims Processing, Banking and Insurance Careers.

Billing work - Empanelled Medical Agencies Follow up with empanelled medical agencies for timely submission of bills. Coordinate with medical agencies to ensure smooth service delivery to the IIMA community. Verify bills received from medical agencies to ensure accuracy and compliance with contractual terms. Obtain necessary approvals from senior management to process bills. Send verified bills to the Accounts Office for payment processing. Medical Reimbursement Process - Collect medical reimbursement forms from IIMA staff. - Verify form details against supporting documents. - Calculate reimbursement rate as per CGHS, etc. in consultation with MO. - Send queries to users for clarification via email and phone. - Confirm receipt of the medical reimbursement form without queries via email. - Obtain approval from higher authority to process bills. - Send month-wise medical reimbursement forms to the Accounts Office for payment. - Handle medical reimbursement form queries from employees Coordination tasks related to consultation, laboratory services, hospitals, pharmacy stores, and Insurance (TPA): - Track contracts for doctor consultations, laboratory services, hospitals, and pharmacy stores. - Manage contract renewal processes and initiate new contract processing as needed. - Create sanctions and work orders for services rendered by consultation, laboratory, hospitals, pharmacy stores. Digitalization of medical records - Maintaining computerized system to manage various data types and established a digital drive for storing this information securely. The system contains below records - Month wise total medical expenses - Yearly total medical expenses - Employee wise monthly expenses - Individual person wise expenses - Empanel agency wise monthly expenses. - Empanel agency wise Yearly expenses. - Month wise and yearly Pharmacy expenses - Month wise and yearly Laboratory expenses - Month wise and yearly Hospital expenses - Month wise and yearly medical reimbursement expenses Administration activities - Co-ordination (Justification/Quotation/ Sanctions/Work orders/ Utility reports etc.) for various administrative activities - Coordination for arrangement of•'Medical Help Desk.. for Institute events, functions, celebrations and activities. - Assist in PC/Email/Paperwork as required by medical officer - Procuring medical kits during sports events and distribution of kits dorm wise. - Coordination with the medical officer to prepare a budget outlining future equipment requirement for the dispensary. - Procurement and scraping of anything as per need in dispensary and coordination with stores and purchase department. Dispensary Record Keeping - Maintaining an online database for comprehensive record management. - Maintaining all medical record files systematically. - Managing budget-related activities. Dispensary Reception Work Handling - Handling phone calls and incoming patients/employees for dispensary and coordinating with medical officer, other dispensary staff, empanelled lab person, various departments, pharmacy, etc. Maintaining Dispensary Website (https://sites.google.com/iima.ac.in/iimamedical) - Contact numbers, location wise timings of Institute doctors. - Address, Contact Number, timings, and Google location link for below medical services providers to get exact direction from IIMA. - Pharmacy stores - Hospitals - Empaneled Doctors - Laboratory - Various medical forms - Insurance TPA contact details and forms Interested candidate may provide their updated resumes on career@iima.ac.in with subject line "Application for Executive for Dispensary"

i. Review and verification of customer details for issuance of policy ii. Maintenance and updating of Master Policy Database and endorsements iii. Scrutiny of insurance claim documents prior to submission to the insurer iv. Coordinate with branch offices for timely submission of insurance claim documents. v. Coordinate with insurer for timely settlement of claim and submission of additional information or documents sought for processing of claims. vi. Monitor status of claims at various stages for completing necessary procedures as within the stipulated turnaround time. vii. Preparation of periodical reports for review. viii. Accounting of claim accounts as per the defined procedures. 1. Good communication skills in English (Speaking and Writing) is must. 2. Speaking proficiency in Hindi is desirable. 3. The candidate should have knowledge of Microsoft Excel should be capable of applying basis tools and techniques for data analysis. 4. Basic knowledge of accounting is an added advantage 5. The candidate should possess good communication and interpersonal skills 6. Candidates capable for speaking languages other than their mother tongue and English is preferable. Contact number : 7337746263 Name : Yathish P Email ID : yathish.p@nabfins.org

The ideal candidate for this role will have experience in managing TPA processes and insurance claims. Your strong communication and interpersonal skills will be essential in effectively coordinating with third-party administrators. Additionally, your ability to maintain accurate patient records and documentation will contribute to the smooth processing of claims. You should be detail-oriented with strong organizational skills to ensure all TPA processes are handled efficiently. Proficiency in using relevant software and systems related to TPA coordination is necessary for this position. Prior experience in the healthcare industry would be advantageous. A bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred for this role.,

As a healthcare insurance coordinator, your responsibilities will include handling patient admission and discharge formalities related to insurance claims. You will be required to coordinate with Third Party Administrators (TPAs) and insurance companies for pre-authorization approvals and final settlements. It will be part of your role to verify and maintain insurance documents, ID cards, and policy details of patients while ensuring accuracy and compliance with regulatory norms. Your duties will also involve following up with TPAs for approvals, queries, and claim settlements, as well as ensuring the accurate and timely submission of medical records, bills, and discharge summaries to insurers. You will be expected to educate patients about the insurance process, coverage limits, and exclusions, providing them with necessary information and support. Maintaining TPA Management Information System (MIS) reports, tracking claim statuses, and resolving any discrepancies or rejections related to claims in coordination with doctors and insurers are essential aspects of this role. Additionally, you will assist the billing team in generating and auditing insurance-related invoices, contributing to the smooth functioning of the billing process. Building and maintaining strong relationships with TPA representatives for seamless coordination will be crucial for success in this position. You will be required to ensure compliance with Insurance Regulatory and Development Authority of India (IRDAI) norms and hospital protocols, upholding high standards of service delivery and efficiency. If you are a detail-oriented individual with a background in insurance verification and a keen interest in healthcare administration, we encourage you to apply for this full-time, permanent position based in Chennai, Tamil Nadu. A Bachelor's degree is preferred, along with at least 1 year of experience in insurance verification. Join our team and enjoy benefits such as health insurance, paid sick time, and Provident Fund contributions. You will work day shifts with the opportunity for a quarterly bonus, contributing to a rewarding and fulfilling work experience. Should you have any further queries or wish to apply for this role, please contact Karthik HR at 7338777993. We look forward to welcoming you to our team and working together to provide exceptional healthcare services to our patients.,

• 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. • 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. Interested candidate can share your resume to varsha.kumari@mediassist.in

1. Conducting surveys in field and assessment of loss. 2. Coordinating with insured for claim documents & processing. 3. Monitor the process flow of allotted claims from registration to settlement. 4. Coordinating with repairer on settlement and payment reconciliation. 5. Building relationship with internal and external customer Education - Diploma, BE -Mechanical/Automobile

"Get a exposure to work in Top Notch Global Health care organization as a intern" * Only BCOM,BBA , BA, BSC,BBM Graduates can apply ( NO BE/BTECH AND MBA/ POST GRADUATES * Only 2023,2024,2025 GRADUATES CAN APPLY ( Provisional certificate is mandatory) Position Requirements & Key Details: Contract Duration: 6-month contract with potential for conversion to a permanent role based on performance Rotational Shifts: Which include night shift( Candidate must open to work night shift based on business requirement) Transportation: Two-way company-provided transportation for all shifts Training: Comprehensive 3-week training covering domain knowledge and essential Excel skills Opening is for one of the Global Healthcare Company Position : Enrollment Claims (Business Operations) Job Description : Analyze insurance claims in accordance with standard operating procedures Resolve routine issues by following established guidelines and precedents Collaborate primarily with your team and direct supervisor; all tasks will come with clear instructions Understand and apply process documents provided by the client Navigate and work across multiple client applications to capture and process required information Consistently meet targets related to productivity, schedule adherence, and quality Comply with all company policies and procedures Interested Candidate can share your updated resume/contact for further clarification thulasi.r@ascent-online.com / 8105586998 Regards Talent Acquisition Specialist Thulasi R 81085586998

Role:AR Analyst( Medical Billing background) Exp: 0.6-1 year Salary: 21k Must Have : Resolve issues related to unpaid medical claims, denied claims Review and appeal unpaid and denied claims. Shift:General Location: Chennai Regards Sowmiya 9600445623

Overview JOB Description of ARDM - Associate Recruitment Development Manager Develop marketing strategies and promote all types of new insurance contracts or suggest additions/changes to existing ones Breed productive relationships to create a pool of prospective clients from various sources by networking, cold calling, using referrals etc Evaluate business or individual customers needs and financial status and propose protection plans that meet their criteria Work with clients to deliver risk management strategies that fit their risk profiles Report the progress of monthly/quarterly initiatives to stakeholders Maintain bookkeeping systems, database and records Monitor insurance claims to ensure mutual satisfaction Achieve customer acquisition and revenue growth objectives Constantly update job knowledge and learn about new products and services Fulfill all policy requirements Criteria: Age - Below 40 CTC: 2.5 - 3.99 Lacs Education: Graduate & above Before applying for this position you need to submit your online resume . Click the button below to continue.

Overview Roles & Responsibilities: 1) Candidates Should have worked in hospital Insurance desk 2) Provide Medical opinion for health Insurance claims 3) Processing of cashless requests & Health Insurance claims document 4) Proficient with medical terms & system 5) Understanding of policy terms & system. 6) Understanding of Claims adjudication/ Claims Processing Tagged as: insurance Before applying for this position you need to submit your online resume . Click the button below to continue. Related Jobs RELATIONSHIP OFFICER IN BANK Bank Jorhat Full Time 2024-01-19

Summary: We at @Prudent Insurance Brokers, are seeking an experienced Employee Benefit-Claims Service Support professional for our International Business (IB) vertical. Employee Benefits Practice at Prudent is a strategic business unit dedicated to strengthening Prudents global brand in the international market. The individual will be responsible to Serve as primary point of contact for all employee claim queries etc. We are committed to delivering bespoke Benefit & Total Reward Solutions with high standards of service excellence, world-class advisory and consultancy support for MNC clients who have their operations in India. Our team forms a bridge of trust between the expectations of senior stakeholders globally and the seamless delivery of these best practices in India. Roles & Responsibilities: • 1) Exceptional Employee Experience Support system by Prudent Serve as primary point of contact for all employee claim queries and own the process of developing strong employee relationships & engagement 2) Facilitating the cashless and reimbursement process: Ensuring employees understand the steps involved in both cashless and reimbursement claims. Offering exceptional support and guidance to employees/HR throughout the entire process to ensure a smooth experience. 3) E-cards/network hospitals: To provide employees e-cards and information about network hospitals. 4) Providing claim-related queries: Addressing questions about claim status, claim deductions, and explanations of queries. 5) TPA Co-ordination: Co-ordinating with TPA daily to ensure the smooth functioning of employee-related queries 6) Employee Engagement & Support SPOC: Daily tracking of claims on status/rejections/deductions and providing the report to MCS Desired profile/who should join: Good listening & communication skills Should have good technical knowledge about Employee health Insurance/ General Insurance products. (Cashless/Reimbursements) Experience in General Insurance/ Insurance Brokers Years of experience: 2 to 5 years Education qualification: Bachelor's Degree, Master's Degree Good knowledge of the TPA/Insurance processes Well-versed in health insurance policy conditions Well-versed with current medical practices & advancements Should know about IRDAI health regulation

Claims Executive Responsibilities: Receiving and answering emails, telephone calls related to claims Advice policyholders on claim procedure Ensure fair settlement of a claim with TAT Manage all administration aspects of the claim Adhere to legal requirements, industry regulations and customer quality standards set by the company. Handle any complaints associated with a claim Claims Executive Requirements: A bachelor's degree in any discipline. At least 2-4 years' experience as a claims handler or a similar role. Excellent time management skills and organizational abilities. Top-notch client interaction skills. Ability to work in a high-pressure environment. A general understanding of insurance terminology and abbreviations. Attention to detail and process-orientated thinking. The ability to work independently and multitask. Proficient in basic computer handling.

We are seeking a competitive Insurance Agent to drive new business growth by engaging with potential clients. Your primary responsibilities will include selling, soliciting, differentiating, and negotiating insurance plans tailored to the specific needs of your assigned or potential customer base. Your main objective will be to cultivate strong, positive relationships to facilitate business expansion, achieve growth targets, and enhance our company's reputation. Your duties will involve developing marketing strategies, recommending new insurance contracts or modifications to existing policies, and establishing a network of prospective clients through various channels such as networking, cold calling, and referrals. Your expertise will be crucial in assessing clients" requirements and financial positions to propose suitable protection plans and deliver tailored risk management solutions. You will be expected to provide regular updates on the progress of monthly and quarterly initiatives to stakeholders, manage bookkeeping systems and records, oversee insurance claims, and meet customer acquisition and revenue growth goals. Continuous learning about new products and services, updating job knowledge, and ensuring policy compliance will also be part of your responsibilities. The ideal candidate should have prior experience as an Insurance Agent or in a related field, possess knowledge of various insurance plans including automobile, fire, life, property, and medical coverage, demonstrate basic computer skills and statistical analysis proficiency, and exhibit a track record of goal-oriented work. Strong communication, presentation, influencing, and selling skills are essential, along with a proven ability to deliver client-centric solutions, forge lasting relationships, and hold a graduate degree. This is a full-time position that requires candidates to have at least 1 year of experience as an Insurance Agent, familiarity with a variety of insurance plans, basic computer knowledge, and proficiency in statistical analysis. Additionally, having 4 years of experience in the wealth channel and 1 year of experience in ULIP sales would be advantageous. Note: We are specifically looking for candidates from Bajaj Allianz LI (BALIC). Applicants are requested to provide their PAN number and specify their desired work location.,

Manage end-to-end claims process for corporate insurance policies (GMC, GPA, WC, Fire, etc). Coordinate with clients, insurers, and TPAs to ensure timely documentation and settlement . Track claim status and provide regular updates to clients. Analyze claim patterns and support clients with insights and loss mitigation strategies. Ensure service level agreements (SLAs) are met and maintain claim MIS reports. Assist clients during audits or investigations, where required. Requirements: Minimum 2 years of experience in corporate insurance claims handling. Strong understanding of Group Mediclaim , GPA , and WC policies. Excellent communication and client coordination skills. Organized, detail-oriented, and comfortable handling multiple cases. Knowledge of insurer and TPA claim portals is a plus.

Role & responsibilities - manage risk across claims and underwriting processes. This leadership role requires close collaboration with multiple internal teams, including Claims, FWA, Retail Underwriting, Sales and Actuarial departments, to drive business performance, ensure regulatory compliance, and maintain effective governance. Monitor overall claims and underwriting portfolio performance by analyzing trends throughout Channels. Collaborate with Channel Heads and ground teams to define actionable plans for addressing unproductive or loss-making claims segments, fraud identification and prevention; etc. Lead initiatives to reduce claims costs, mitigate losses in unprofitable cohorts, and improve customer experience Conduct process reviews to identify and control processing errors, transaction outliers, and implementation risks. Develop and execute risk mitigation strategies to ensure smooth adoption of new processes and strategies. Manage audits and resolve findings related to Claims and Underwriting, including IRDA, internal, statutory, and other audits. Lead quality checks for processed claims (in-house and TPA) through concurrent/retrospective audits and system validation. Conduct audits of NEFT/Payment processes and clinical coding to ensure accurate system adjudication and effective data analytics. Enhance documentation and reporting accuracy within the Claims function. Oversee governance within the Claims and Underwriting teams to align with company objectives.

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

Positions General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims 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 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. 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: 3+ 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. ***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."

Responsible for managing hospital insurance operations, including claim processing, TPA coordination, documentation, compliance, and team supervision to ensure timely reimbursements and reduce claim denials.

At Alight, we believe a company s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to Be Alight. Our Values: Champion People - be empathetic and help create a place where everyone belongs. Grow with purpose - Be inspired by our higher calling of improving lives. Be Alight - act with integrity, be real and empower others. It s why we re so driven to connect passion with purpose. Alight helps clients gain a benefits advantage while building a healthy and financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, absence management and navigation. With a comprehensive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work. Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight. Learn more at careers.alight.com . The Alight Operations Team is responsible for providing timely and accurate customer service through any/all the mediums- email, phone and web chat, requiring strong communication skills and knowledge of client plans and provisions to resolve the participants issues. We strive for first-call resolution while adhering to service level agreements, ensuring a positive participant experience through effective solutions and personal service. Responsibilities Handling claims related to FMLA, disability (STD/LTD), parental leave, personal leave, and other applicable programs. Taking a decision on leaves, resulting in either approval, denial or extension of the leaves. Managing and processing employee leave claims in compliance with federal, state, and company policies. Articulate complex client plans and provisions in a simplified and understandable manner to take an informed decision meeting client SLA s. Maintain internal & client defined quality scores. Consistently meet or exceed KPIs. Ensuring proper documentation and follow-ups in accordance with SOPs. Identifying issues, process delays, and quality problems and recommending and implementing solutions. Execute Issue/Query/ Workflow Resolution Ongoing client delivery of quality service /audits & First level quality check. Consistently applying logical reasoning and critical thinking skills. Ability to work in a fast-paced environment with short deadlines. Take complete ownership of self-learning & development Requirements Bachelor s degree in BCom, B.A, BBA (Full time MBA/MCA/B Tech/BE/B Ed candidates will not be considered). Associate Level hires: 2-5 years of work experience in Insurance Claims/Leave claims and Backend Operations (International Voice /Non-Voice/Blended process) Analyst Level hires: 5 - 8 years of work experience in Insurance Claims/Leave Claims and Backend Operations (International Voice/Non-Voice/Blended process) Outstanding customer service skills Excellent verbal and written communication skills. Basic computer knowledge (MS-Office, Excel) Good analytical skills & attention to detail. Ability to work evening/night shifts Alight requires all virtual interviews to be conducted on video. Flexible Working So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and Top 100 Company for Remote Jobs 5 years in a row. Benefits We offer programs and plans for a healthy mind, body, wallet and life because it s important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as several voluntary benefit options. By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight s employment policies. Background checks may include some or all the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, credit check, and/or drug test. You will be notified during the hiring process which checks are required by the position. Our commitment to Inclusion We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful. At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future. As part of this commitment, Alight will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact alightcareers@alight.com . Equal Opportunity Policy Statement Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. In addition, we take affirmative action to employ, disabled persons, disabled veterans and other covered veterans. Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request a reasonable accommodation/modification by contacting their recruiter. Authorization to work in the Employing Country Applicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the Employing Country and with Alight. Note, this job description does not restrict managements right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units. We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization. DISCLAIMER: Nothing in this job description restricts managements right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units. .

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check 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

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 company s 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. NTT DATA, Inc. currently seeks a BPO HC & Insurance Operations Senior Representative to join our team in "Chennai or Coimbatore " Positions General Duties and Tasks Required. In this Role you will be Responsible For : - Read and understand the process documents provided by the customer - Analyze the insurance claims and process as per standard operating procedures - To understand and calculate (COB - Coordination of Benefit) the patients responsibility and perform insurance calculations - Familiarize, navigate multiple client applications and capture the necessary information to process insurance claims Requirements for this role include: - 0 -1 Year of experience in any Healthcare BPO - University degree or equivalent that required 3+ years of formal studies - Candidates with good typing skills with 25 WPM or completed typewriting lower preferred or good to have - 1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. - Ability to work scheduled shifts from Monday-Friday 06:00 PM to 04:00 AM and to be flexible to accommodate business requirements - Ability to communicate (oral/written) effectively in English to exchange information with our client.In this Role you will be Responsible For : - Read and understand the process documents provided by the customer - Analyze the insurance claims and process as per standard operating procedures - To understand and calculate (COB - Coordination of Benefit) the patients responsibility and perform insurance calculations - Familiarize, navigate multiple client applications and capture the necessary information to process insurance claims Requirements for this role include: - 0 -1 Year of experience in any Healthcare BPO - University degree or equivalent that required 3+ years of formal studies - Candidates with good typing skills with 25 WPM or completed typewriting lower preferred or good to have - 1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. - Ability to work scheduled shifts from Monday-Friday 06:00 PM to 04:00 AM and to be flexible to accommodate business requirements - Ability to communicate (oral/written) effectively in English to exchange information with our client.