40 Medical Claims Jobs

Experience : 0-12 months Qualification : MSC, B.Pharma, M.Pharma Key Responsibilities: Good communication skill. Knowledge in computers like MS office. Good medical knowledge. Independently process Post hospitalization claims; process complex claims with minimal assistance Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information Suggest operational policies, workflows and process improvement initiatives Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same. Applying medical and surgical aspects to sc...

Qualification: MSC, B.Pharma, M.Pharma Key Responsibilities: Good communication skill. Knowledge in computers like MS office. Good medical knowledge. Independently process Post hospitalization claims; process complex claims with minimal assistance Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information Suggest operational policies, workflows and process improvement initiatives Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same. Applying medical and surgical aspects to scrutinize the patient repor...

Job Profile Quality Assurance, Quality Control, Clinical Research , Regulatory Affairs, Medical Record Summarization , Medical Claims , Medical Officer, Medical Billing , Pharmacist, ADL, ARD, FRD, CDM, Production, R&D , Lab Technician

Key Responsibilities: Medical Review & Claims Adjudication: Assess and validate medical claims based on clinical documentation and policy coverage. Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility. Coordinate with internal medical teams to ensure accuracy in claims decision-making. Customer Interaction & Support: Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner. Handle escalated or complex customer service issues involving medical claims. Offer support and guidance on claim submission processes and documentation requirements. Compliance & Documentation:...

As an Associate Consultant in Real World Analytics at IQVIA, your role involves performing, managing, and coordinating data analysis activities using IQVIA Connected Intelligence Real-World Data and clinical data assets across multiple R&D projects. You will work closely with Therapeutic Analytic Leads to support initiatives and ensure consistency in the use of data, tools, and processes. **Key Responsibilities:** - Utilize IQVIA Connected-Intelligence datasets to develop and refine clinical trial strategies pre- and post-award. - Collaborate with internal stakeholders to align on data analytics requirements, capabilities, and deliverables. - Lead the methodology and execution of analytics s...

Job Description: Are you ready to build your career in Revenue Cycle Management (RCM) R1RCM Global Pvt Ltd is looking for both freshers and experienced professionals from an RCM background to join the growing team. Please note that non-RCM experienced candidates with more than 2 years of experience are not eligible for this position. Key Responsibilities: - Specializing in medical claims (AR) for U.S. medical billing. - Participate in Walk-In Interviews held from Monday to Friday at Tower No-1, Candor Tech Space, Sector 48, Gurugram, Haryana 122018. - Bring your updated resume and be a part of a dynamic, fast-growing organization that is shaping the future of healthcare billing. Qualificatio...

Job Title: AR Caller Denial Management (Voice Process) Location: Bangalore Experience: 1 3 Years Shift: Night Shift (US Shift) Mode: Work from Office Cab Facility: 2-way transportation provided Job Description: We are hiring experienced AR Callers for our Denial Management process in the US Healthcare domain. The ideal candidate should have excellent communication skills and a strong understanding of revenue cycle management (RCM). Key Responsibilities: Handle denied and unpaid claims effectively through calling insurance companies. Understand and resolve denial reasons and ensure timely follow-up. Work on claims status , appeals , and re-submissions as needed. Maintain quality and productiv...

Experience: 0-12 months Qualification: BAMS Key Responsibilities: Good communication skill. Knowledge in computers like MS office. -Good medical knowledge. -Independently process Post hospitalization claims; process complex claims with minimal assistance -Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information -Suggest operational policies, workflows and process improvement initiatives -Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same. -Applying medical and surgical aspects to scrutinize the pa...

As a Claims Adjudicator (Medical Claims/Medical Malpractice) at our company, your role will involve reviewing and processing medical claims to ensure accuracy and compliance with regulations and policies. You will also handle claims related to medical malpractice, assessing liability and determining appropriate actions. Your decision-making skills will be crucial as you make informed decisions on claims, considering medical records, policy terms, and relevant laws and regulations. Your qualifications for this role should include at least 6 years of experience in claims adjudication, preferably in the medical or insurance industry. A strong understanding of medical terminology, procedures, an...

Role Overview: You will be responsible for preparing, reviewing, and submitting medical claims to insurance companies in this role. Key Responsibilities: - Prepare, review, and submit medical claims to insurance companies Qualification Required: - No specific qualifications mentioned in the job description About Company: At QHT Clinic, they specialize in delivering reliable, undetectable, sustainable, and best-in-class hair restoration results. With over 10,000 successful surgeries, they have earned the trust of patients across India and abroad. Their advanced QHT (Quick Hair Transplant) technique, a modern evolution of the FUE method, ensures minimal downtime, natural hairlines, and long-la...

Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: MBBS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office.

MDINDIA HEALTH INSURANCE TPA PVT LTD is looking for Medical Claims Auditor to join our dynamic team and embark on a rewarding career journeyAudit claims to ensure adherence to regulatory and policy standards. Analyze discrepancies and report findings to management. Provide recommendations to improve claim processing accuracy.

MDINDIA HEALTH INSURANCE TPA PVT LTD is looking for Medical Claims Processors-BAMS/BHMS to join our dynamic team and embark on a rewarding career journeyVerify medical claims for accuracy and completeness. Ensure compliance with insurance policies and regulatory guidelines. Coordinate with healthcare providers for necessary documentation. Approve or deny claims based on eligibility criteria.

Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: MBBS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office.

Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BAMS / BHMS / BDS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office.

Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BAMS / BHMS / BDS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office.

Role Overview: You will be responsible for ensuring accuracy, compliance, and continuous improvement in healthcare claim processing in the role of a Quality Specialist, focusing on claims adjudication processes in the US Healthcare domain. Your role will involve identifying trends, errors, and areas for improvement, collaborating with teams to address quality gaps, preparing audit reports, maintaining documentation, supporting process improvement initiatives, and ensuring regulatory standards adherence. Key Responsibilities: - Identify trends, errors, and areas of improvement in claims adjudication processes - Collaborate with operations and training teams to address quality gaps and impleme...

Greetings...!! We have the requirement for Client: I Space Software India Pvt Ltd Location: Madhapur ,Hyderabad Working Mode : WFO Time : 7:00 PM - 4:00 AM ( US Shifts ) Working Days : 5 Days ( Sat & Sun fixed Weekoff) F2F Interview JD: Experience in interacting with international US customers / Clients Experience on eligibility verification ( EBV) Awarenesson us health insuranceguidelinesthe claims submission process and procedures Analysisexplanation of benefits(EOB) forms toensure insurance companieshave paid for charges Followingup with the appropriateparties( insurancecompanies and patients ) to ensurebills are paid Understandand Analyzethe patient's records interacting the Physicians a...

The Accounts Receivable Caller, also known as AR Caller, is a crucial team member in the healthcare revenue cycle. Your primary responsibility will involve communicating with insurance companies and patients to effectively follow up on unresolved medical claims. You will need to navigate through intricate billing and coding procedures to guarantee accurate reimbursement for the healthcare services provided. As an AR Caller, you will be expected to initiate calls to insurance companies to resolve claims and conduct necessary follow-ups. You must also address any inquiries from patients regarding billing matters, ensuring that you provide them with clear and concise explanations. Collaborating...

You are a Senior Data Analyst in the Professional Services team at Analytical Wizards, located in Bangalore. Your role involves developing custom reports, conducting complex data analysis, and catering to client-specific data requirements. Your expertise in SQL, data manipulation, and healthcare analytics will be invaluable in delivering actionable insights and solutions. You will collaborate with internal teams and clients, ensuring data integrity, accuracy, and quality across all deliverables. Your responsibilities include developing and delivering custom data extracts and reports using SQL, Excel, and Python. You will analyze large-scale healthcare datasets to derive valuable insights and...

Role:AR Analyst( Medical Billing background) Exp: 0.6-1 year Salary: 18 - 20k Must Have : Denial management, Resolve issues related to unpaid medical claims. Shift:General Direct Walk-in NP: Immediate Location: Chennai Regards Sowmiya 8870213772

You will be joining our team as a Medical Claims Call Center Representative, bringing your highly motivated and experienced background in the medical field. Your main responsibility will involve handling inbound customer calls regarding claims and claim rejections. Providing exceptional customer service by effectively resolving customer inquiries and concerns will be your primary focus. Your duties will include answering incoming customer calls in a professional and timely manner, assisting customers with inquiries related to medical claims, and providing accurate information on claim procedures, documentation requirements, and coverage. You will investigate and resolve customer concerns, en...

Urgent Job Opening Quality Assurance, Quality Control, Clinical Research , Regulatory Affairs, Medical Record Summarization , Medical Claims , Medical Officer, Medical Billing , Pharmacist, ADL, ARD, FRD, CDM, Production, R&D , Lab Technician

Involved in Analyzing Medical Reports to Process Medical Claims. Processing/Approving Medical claim Scrutinizing medical documents Providing Medical opinions Medical Audit Checking the validation of Hospitalization.

Contact insurance companies in the US to follow up on unpaid or denied medical claims Review patient account information resolve denials or rejections Work on hospital billing claims Analyze denial codes, understand reason for denials Required Candidate profile Document update the system with call outcomes and next steps Ensure adherence to HIPAA guidelines internal quality std Meet daily and weekly targets for call volume resolution Communicate effectively Perks and benefits Perks and Benefits