619 Insurance Claims Jobs - Page 8

Role & Responsibilities Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Outstanding follow-up with TPA. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies to pass or clear the Health Insurance claims. Qualifications Bachelor's degree. Previous experience in TPA management or Banking. Good interpersonal and communication skills. Isha Thakur 9056448144 HRD

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation 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

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

Role & responsibilities Manage insurance claims from receipt to settlement, ensuring timely processing and resolution. Coordinate with TPAs (Third Party Administrators) for claim adjudication and settlement. Handle mediclaim claims, health insurance claims, and other types of general insurance policies. Ensure accurate billing and reconciliation of patient accounts. Maintain records of all interactions with patients, providers, and insurers. Preferred candidate profile 5-8 years of experience in insurance coordination or TPA coordination role. Strong knowledge of insurance billing, claims processing, and claims settlement procedures. Proficiency in handling multiple tasks simultaneously under tight deadlines. Excellent communication skills for effective interaction with customers (patients), providers (hospitals), and insurers. Perks and benefits As per industry

About Plum Plum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations. Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance. Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners. About the role The primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred. PRINCIPAL ACCOUNTABILITIES Processing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy. Responsible for the following transactional activities Scrutiny of reimbursement claims Submission to Insurer Informing incomplete documentation requirement to the employees Liaising with employees in explaining the reason for requirements/plum rejections Leading team of claims experts who guides the employees to submit the claims Collaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submission Communicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepancies Maintaining accurate records of claims processing activities and documentation for audit and reporting purposes. Providing customer service support to address inquiries and concerns related to reimbursement claims. Working with Insurance companies to ensure that eligible claims are paid completely to the end customer

Project Role : Product Owner Project Role Description : Drives the vision for the product by being the voice of the customer, following a human-centered design approach. Shapes and manages the product roadmap and product backlog and ensures the product team consistently deliver on the clients needs and wants. Validates and tests ideas through recurrent feedback loops to ensure knowledge discovery informs timely direction changes. Must have skills : Insurance Claims Good to have skills : NAMinimum 3 year(s) of experience is required Educational Qualification : minimum 15 years of fulltime educationJob :Key Responsibilities:A:Strong understanding of P&C Insurance End to End claims lifecycle and Claim Process management Retrieve and review insurance claims for policies, verify policy coverages, loss evaluation, Reporting, Payment processing and claims settlements methods. B:Experience on P&C Claims application/system from creation of FNOL, financial reporting, reserving to completion of claim settlement. C:Thorough understanding of claim Assessment and Evaluation know-how of claim evaluation based on policy terms and conditions, Calculation of claim amount, identify Process Improvement for streamlining existing claims processes and reduce operational inefficiencies by developing and documenting process improvement strategies and workflows within existing systems. D:Drive Business discussions, facilitate business elicitation and walkthrough sessions, propose Business solutions, and manage stakeholders. E. Understand Data, data flow, Report creation/generation and basic understanding of database. Technical Experience :A:Candidate must have strong Claims business knowledge and technical knowledge of process flow in Application B:Work closely with quality assurance team to ensure high quality delivery for web applications, Experience with Guidewire /Duck Creek Claims or any COTS suites is required C:Ability to provide Training and Support to fellow Peers and Automation teams about existing/new processes to provide ongoing support and assistance to claims teams as needed. D:Work closely with multiple stakeholders for System Integration - IT teams to ensure that software and technology solutions align with business requirements, participate in the design and implementation of claims management systems. E Knowledge of basis SQL queries and Databases. Professional Attributes:A:Analysis skills B:Having good communication skill C. Can work in close collaboration with Team. Educational Qualification:minimum 15 years of full-time education Qualification minimum 15 years of fulltime education

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS, B.sc Nursing, BPT mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS, B.sc Nursing, BPT mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in

Primary Responsibilities: • Responsible for Quotes generation, Policy Issuance, Policy Cancellation / Endorsement issuance / Refunds etc. for all channels / products of respective branch within defined TATs. • Providing support for faster claim settlement in coordination with the respective stakeholders. • Ensuring 100% Policy Issuance through Policy Issuance Portal for respective branch as per defined TAT. • Supporting customers / PoSPs of respective branch in terms of timely resolution of their issues / concerns in coordination with respective stakeholders. • Following up with ICs / IT / HO Operations Team for timely resolution of raised tickets / issues of respective branch. • Establishing strong connect with insurance companies / hospital network / Garages / Mahindra eco system & other respective stakeholders.

Job Description: Our client, a leading AI platform specializing in medical billing operations, is seeking dedicated and detail-oriented Medical Billing and Insurance Claims Specialists to join our team. The ideal candidates will have at least 6 months of experience in medical billing, insurance claims, or a related field and possess strong English proficiency . As part of our client-facing team, you will be providing vital support to client operations by ensuring accurate and compliant medical billing operations through outbound calling, data categorization, and transcript analysis. Key Responsibilities: Outbound Calling: Make outbound calls to insurance companies and payors to collect essential information, including claim statuses, denial reasons, and any additional relevant details. Conduct all calls in full compliance with the companys guidelines and applicable healthcare regulations. Maintain professionalism and ensure clear communication during each call. Data Categorization and Labeling: Accurately record, categorize, and label calls or information gathered using the taxonomy and definitions provided by the client. Ensure all claim statuses and call outcomes are properly labeled for consistency in reporting and easy analysis. Deliver categorized data in periodic reports or through the portal developed by client, following the requested format and frequency. Call Transcript Analysis: Analyze recorded call transcripts to extract actionable insights, identifying trends, recurring denial reasons, and other patterns. Compile findings into periodic reports, providing valuable information to the Client to support process improvements and optimize workflows. Qualifications: Minimum of 6 months of experience in medical billing, insurance claims, or a related field. Strong English proficiency , both verbal and written. Familiarity with healthcare regulations and industry guidelines. Excellent communication skills with the ability to make outbound calls to insurance companies and payors. Detail-oriented and able to maintain accurate records. Ability to work independently while adhering to internal guidelines and procedures. Proficiency in Microsoft Office Suite or similar software; experience with medical billing software is a plus. Additional Information: This is a full-time position, and the successful candidate will work closely with the clients team to support their AI-powered platform in improving medical billing operations. The role offers an opportunity for professional growth and development within a dynamic, technology-driven environment.

Datamatics Global Services LTD, Nashik is hiring for the Fraud Analyst / Risk Analyst position for GURGAON SECTOR-44 Kindly share you resume: durga.gaikwad@datamatics.com Kindly refer to the below JD. Note : Feel free to contact us in case of any reference - 02536102006 Requirement: Graduate : BCOM / MCOM/ MBA FINANCE Experience of Insurance sector Preference to Insurance sector. Fraud Analyst, Risk Control / Claims Department Good command on English Verbal & Written Good knowledge of MS Excel & Word Email writing Ready to work in flexible working hours. Kindly share you resume: durga.gaikwad@datamatics.com Also share the details below with us. Total Experience: Current CTC: Expected CTC: Notice Period: Ready to 6 days working:

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Tanishaa Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432422 WhatsApp: 7899490271 | | Tanishaa.S@blackwhite.in | www.blackwhite.in

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

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Sneha Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432406| sneha.v@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Deekshitha Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432405| deekshitha@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA Note : NA -- Thanks & Regards, HR Amala Subject Matter Expert Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432406| amala@blackwhite.in | www.blackwhite.in

Job Title : Claims Admin (Sr Process Executive) Qualification : Any Graduate Experience : 1-4 Years Must Have Skills : l Working experience in SAP. Experience in English communication skills both written and verbal. The ability to work within a deadline focused environment. Excellent knowledge of MS word, excel, Work from office Good to Have Skills : NA Roles and Responsibilities : Claims Administration: l Good understanding on claim processing, creating claims/tickets, dealing with suppliers, credit note handling investigation, follow up on credit note, Booking CN, Creation of Manual RFC (request for credit) l Match RFC to credit, categorize of items refund process. Idea on debit note l Good understanding on dealing with damaged products l Provide refund to store n franchise, dealing with supplier, refund process for damaged products fixit tickets idea on credit note Location : Pune CTC Range : 3.5 - 5.5lpa (lakh per annum) Notice period : Immediate - 30 Days Shift Timings : UK Shift Mode of Interview : Virtual Mode of Work : WFO (work from office) Mode of Hire : Permanent Note : NA Note : NA -- Thanks & Regards, HR Sanjana Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432421| sanjana.b@blackwhite.in | www.blackwhite.in

NTT Data Services is Hiring! Positions Overview 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. Clients business problem to solve? For more than 30 years, our Business Process Outsourcing (BPO) team has implemented the processes and technologies for our clients that bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction Positions General Duties and Tasks In these roles you will be responsible for: Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables. Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met Analyzing medical insurance claims for quality assurance Resolving moderately routine questions following pre-established guidelines Performing routine research on customer inquiries. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Identify the outstanding claims with payers through the reports from clients Place calls with payers with regard to outstanding claims Document the details of the calls made to payers in DBPMS and the client software Coordinate with the team leader in following the processes Requirements for this role include: Ability to work regularly scheduled shifts from Monday-Friday 17:30pm to 3:30am IST. University degree or equivalent that required 3+ years of formal studies of the English language. 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. 6+ months of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English. 6+ months of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions Preferences: - Ability to communicate (oral/written) effectively to exchange information with our client . *** The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend s basis business requirement. *** All new hires will be required to successfully complete our Orientation/Process training classes and demonstrate proficiency of the material.

. Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Performs Claims duties under direct instruction and close supervision. Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. Monitor and highlight high-cost claims and ensure relevant parties are aware. Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable. Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. Interface effectively with internal and external customers to resolve customer issues. Identify potential process improvements and make recommendations to team senior. Actively support other team members and provide resource to enable all team goals to be achieved. Work across International business in line with service needs. Carry out other ad hoc tasks as required in meeting business needs. Work cohesively in a team environment. Adhere to policies and practices, training, and certification requirements. Requirements*. Working knowledge of the insurance industry and relevant federal and state regulations. Good English language communication skills, both verbal and written. Computer literate and proficient in MS Office. Excellent critical thinking and decision-making skills. Ability to meet/exceed targets and manage multiple priorities. Must possess excellent attention to detail, with a high level of accuracy. Strong customer focus with ability to identify and solve problems. Ability to organise, prioritise and manage workflow to meet individual and team requirements. Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential. Education*: Graduate (Any) - medical, Paramedical, Pharmacy or Nursing. Experience Range*: Minimum 1 year of experience in healthcare services or processing of healthcare insurance claims. Foundational Skills* - Expertise in international insurance claims processing . Join us in driving growth and improving lives. Understands simple instructions and procedures. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Strong interpersonal skills. Ability to work under own initiative and proactive in recommending and implementing process improvements. . Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities, and shareholders every day. One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We are devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being. CIGNA Healthcare believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization. Working at CIGNA Healthcare will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us! Process Overview* - International insurance claims processing for Member claims. Job Description* - Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles. Responsibilities: - - Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. - Monitor and highlight high-cost claims and ensure relevant parties are aware. - Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable. - Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. - Interface effectively with internal and external customers to resolve customer issues. - Identify potential process improvements and make recommendations to team senior. - Actively support other team members and provide resource to enable all team goals to be achieved. - Work across International business in line with service needs. - Carry out other ad hoc tasks as required in meeting business needs. - Work cohesively in a team environment. - Adhere to policies and practices, training, and certification requirements. Requirements*: - Working knowledge of the insurance industry and relevant federal and state regulations. - Good English language communication skills, both verbal and written. - Computer literate and proficient in MS Office. - Excellent critical thinking and decision-making skills. - Ability to meet/exceed targets and manage multiple priorities. - Must possess excellent attention to detail, with a high level of accuracy. - Strong interpersonal skills. - Strong customer focus with ability to identify and solve problems. - Ability to work under own initiative and proactive in recommending and implementing process improvements. - Ability to organise, prioritise and manage workflow to meet individual and team requirements. - Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential. Education*: Graduate (Any) - medical, Paramedical, Pharmacy or Nursing. Experience Range*: Minimum 1 year of experience in healthcare services or processing of healthcare insurance claims. Foundational Skills* - Expertise in international insurance claims processing Work Timings*: 7:30 am- 16:30 pm IST Job Location*: Bengaluru (Bangalore) About The Cigna Group Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. . Back to search results Previous job Next job JOB DESCRIPTION Driving Growth. Improving Lives.

Introduction Gear Inc. is seeking a Team Lead (TL) for a BPO (Business Process Outsourcing) company. Ideal candidates are able to adapt and are well-known for fast-moving and last-moment change. Responsibility Manage, inspire, and mentor a group of Process Support Associates (PSA). Hold regular team meetings, evaluate performance, and offer helpful criticism. Manage escalations and challenging situations while advising and supporting PSAs. Make sure that all PSA tasks are completed smoothly and effectively. Keep up with periodic updates and make sure the team follows them. Conduct briefings & process updates to the team to improve their abilities. Handle clients requests and escalations, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution. Should make themselves approachable for PSAs. Report any issues or challenges to the reporting manager immediately when needed. Responsible for checking the roster adherence of PSAs and managing shrinkages of the floor. Assisting team members in identifying trends and establishing teams goals. Ensure team members are achieving daily productivity and desired service levels as per the KPIs; correct action plan to be shared in case of any deviation. Prepare reports and analyze data to improve processes, ensure resources are properly allocated based on the volume trend analysis, and maximize the teams efficiency. Key skills and experience Education: Bachelors degree preferred. Experience: Total experience more than 3 yrs .1+ years in Medical Billing, Insurance Claims, or a related field & 2+ years in TL role Skills: Excellent verbal and written communication skills in English, with the ability to express ideas clearly and concisely. Problem-solving and critical-thinking abilities. Strong team management and leadership abilities. Ability to handle client conversations and multitask. Ability to perform under pressure. Adaptability to fast-paced environments and shift work. Decisiveness and attention to detail. Language Requirement: English: Fluent or Business Proficient (C1 and up). ",

Sign-On Bonus Offered! Join us and receive a competitive sign-on bonus as a welcome to our growing team! Our client, a leading AI platform specializing in medical billing operations, is seeking dedicated and detail-oriented Medical Billing and Insurance Claims Specialists to join our team. The ideal candidates will have at least 1 year of experience in medical billing, insurance claims, or a related field and possess strong English proficiency . As part of our client-facing team, you will be providing vital support to client operations by ensuring accurate and compliant medical billing operations through outbound calling, data categorization, and transcript analysis. Key Responsibilities: Outbound Calling: Make outbound calls to insurance companies and payors to collect essential information, including claim statuses, denial reasons, and any additional relevant details. Conduct all calls in full compliance with client guideline and applicable healthcare regulations. Maintain professionalism and ensure clear communication during each call. Data Categorization and Labeling: Accurately record, categorize, and label calls or information gathered using the taxonomy and definitions provided by the client. Ensure all claim statuses and call outcomes are properly labeled for consistency in reporting and easy analysis. Deliver categorized data in periodic reports or through the portal developed by client, following the requested format and frequency. Call Transcript Analysis: Analyze recorded call transcripts to extract actionable insights, identifying trends, recurring denial reasons, and other patterns. Compile findings into periodic reports, providing valuable information to support process improvements and optimize workflows. Qualifications: Minimum of 6 months of experience in medical billing, insurance claims, or a related field. Strong English proficiency , both verbal and written. Familiarity with healthcare regulations and industry guidelines. Excellent communication skills with the ability to make outbound calls to insurance companies and payors. Detail-oriented and able to maintain accurate records. Ability to work independently while adhering to internal guidelines and procedures. Proficiency in Microsoft Office Suite or similar software; experience with medical billing software is a plus. ",

Introduction Gear Inc. is seeking a Team Lead for BPO (Business Process Outsourcing) company. Ideal candidates are able to adapt and are well known with fast-moving and last-moment change. Responsibility Manage, inspire, and mentor a group of Process Associates (PA). Hold regular team meetings, evaluate performance, and offer helpful criticism. Manage escalations and challenging situations while advising and supporting PAs. Make sure that all PA tasks are completed smoothly and effectively. Keep up with periodic updates and make sure the team follows them. Conduct briefings & process updates to the team to improve their abilities. Handle clients requests and escalations, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution. Should make themselves approachable for PAs. Report any issues or challenges directly to the reporting manager immediately. Will be responsible for checking the roster adherence of PAs and managing shrinkages of the floor. Leading team meetings, asking questions to other leaders to better understand what the PAs are receiving, educating and coaching workers regarding processes and practices, and explain expectations to (CSA). Assisting the team members in identifying trend analysis and establishing teams goals. Ensure the team members are achieving daily productivity and desired service levels as per the KPIs and in case of any deviation correct action plan to be shared. Prepare reports and analyze data to improve processes, ensure resources are properly allocated based on the volume trend analysis and maximize the teams efficiency. Key skills and experience Education: Bachelors degree preferred. Experience: 1+ years in Medical Billing, Insurance Claims, or a related field. Skills Excellent verbal and written communication skills in English, with the ability to express ideas clearly and concisely. Problem-solving and critical-thinking abilities. Strong team management and leadership abilities. Ability to handle client conversations and multitask. Ability to manage delicate material and perform under pressure. Adaptability to fast-paced environments and shift work. Decisiveness and attention to detail. Language Requirement English: Fluent or Business Proficient (C1 and up). Job Type: Full-time Pay: 22,000.00 - 24,000.00 per month Work Location: On-site ",

Senior Executive- IP Billing - Dr Raos ENT Super Specialty International Hospital Senior Executive- IP Billing Job Description JOB DESCRIPTION SENIOR EXECUTIVE IP BILLING 1 Provide counselling to patients, address their concerns, explain treatment procedures, and ensure clarity on the medical process. 2 Notify and update patients regarding their admission process, ensuring smooth communication of admission details. 3 Oversee patient admissions during evening shifts, ensuring all necessary documentation and procedures are completed efficiently. 4 Address and resolve patient queries related to billing, insurance, admission, or treatment in a timely and professional manner. 5 Assist in the preauthorization process for insurance claims, preparing and submitting necessary documentation to the concerned authorities. 6 Prepare and process cash and insurance bills accurately, ensuring all charges are accounted for and submitted according to hospital protocols. 7 Create and maintain a list of realized payments, tracking and updating as per the payments received for both cash and insurance accounts. 8 Ensure all required signatures for patient-related concerns, including medical approvals and financial documents, are obtained from the relevant authorities for compliance. Qualifications Experience: 3 to 5 years Hospital Experience is Required Interested Candidates can reach us out at: Apply for Senior Executive- IP Billing at Dr. Raos ENT Your Resume (in pdf format)

Job Overview: We are looking for an experienced Claims Manager to handle non-motor insurance claims (such as Fire, Marine, Liability, Engineering, and other commercial policies ) for our SME clients. The ideal candidate should have a strong technical understanding of policy wordings, loss assessment, and claims lifecycle management, with the ability to coordinate effectively with surveyors, insurers, and internal stakeholders. Location : Ahmedabad Key Responsibilities: End-to-End Claims Management for non-motor SME policies including Fire, Marine, Liability, Engineering, etc. Coordinate with Insurers and Surveyors for timely claim registration, survey appointments, and assessment updates. Verify claim documents and assist clients in claim documentation and submission. Ensure timely follow-up and track the status of pending and approved claims. Resolve claim-related queries or disputes raised by the clients or insurers. Liaise with internal teams (Sales, Operations, etc.) to ensure seamless customer experience. Maintain and update MIS for claims on a regular basis. Analyze claim trends, recommend process improvements, and reduce TAT. Ensure compliance with IRDAI regulations and company protocols. Interested candidates please share your resume on disha.doshi@probusinsurance.com