Role & responsibilities Selected trainees Will be trained on Claim adjudication process They will evaluate and processes claims in accordance with company policies and procedures per CMS guidelines/SOP Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication Exercises good judgment and remains knowledgeable in related company policies and procedures Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing Gain knowledge of Commercial, Medicaid, Medicare & TPA claims processing guidelines Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc. Knowledge of different providers payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.) preferred Pay or deny per the guidelines/SOP Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols Flexibility with shift according to client need is mandatory He/She will report to Team Lead Fresher with good analytical and communication can attempt for Trainee Preferred candidate profile Fresher who can work in NIGHT SHIFTS ( US Shift timings ) Company transport not available Perks and benefits ESI and PF benefits
Role & responsibilities Java developer with in depth knowledge , Data base technologies Knowledge of Claims processing and Benefits set in payer space US health care domain . Hands on Knowledge of Java developement is a preferred skill Preferred candidate profile Experienced Java developers with Database management experience of min of 5 years who can lead the dept and having good knowledge in Claims processing and US health care domain , Benefits set up in Payer space . Need min of 3 to 5 years experience in both development and health care space This is Work from Office role at Chennai ( US timings)
Role & responsibilities We are seeking a dedicated Utilization Management Specialist to join our Chennai office. In this role, you will be responsible for reviewing and analyzing clinical information to determine the medical necessity and appropriateness of healthcare services, ensuring compliance with established guidelines and policies. Your expertise will contribute to optimizing patient care and resource utilization. Key Responsibilities Conduct prior authorization, concurrent, and retrospective reviews for various healthcare services, including inpatient, outpatient, home health, and behavioral health. Apply evidence-based criteria (e.g., MCG, InterQual) to assess the necessity of medical services. Collaborate with healthcare providers, medical directors, and clinical staff to facilitate appropriate care plans and resource utilization. Maintain accurate and organized documentation of all utilization management activities. Participate in quality improvement initiatives and assist in developing clinical guidelines. Monitor and report on utilization trends to management, identifying areas for improvement. Educational qualifications and Experience : Bachelor's Degree in Nursing (BSc Nursing) or equivalent. Minimum of 2 years of clinical experience in a hospital or healthcare setting. Active and unrestricted Registered Nurse (RN) license in the United States. Familiarity with utilization management processes and guidelines (e.g., MCG, InterQual). Proficient in medical terminology, anatomy, and physiology. Strong analytical and problem-solving skills. Excellent communication skills, both written and verbal. Proficient in Microsoft Office applications. Preferred candidate profile Preferred Qualifications Experience with Medicaid, Medicare, and Managed Care programs. Previous experience in utilization review or case management. Certification in Case Management (CCM) or Accredited Case Manager (ACM) is a plus
Role & responsibilities Selected trainees Will be trained on Claim adjudication process They will evaluate and processes claims in accordance with company policies and procedures per CMS guidelines/SOP Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication Exercises good judgment and remains knowledgeable in related company policies and procedures Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing Gain knowledge of Commercial, Medicaid, Medicare & TPA claims processing guidelines Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc. Knowledge of different providers payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.) preferred Pay or deny per the guidelines/SOP Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols Flexibility with shift according to client need is mandatory He/She will report to Team Lead Fresher with good analytical and communication can attempt for Trainee Preferred candidate profile Fresher who can work in NIGHT SHIFTS ( US Shift timings ) Company transport not available Perks and benefits ESI and PF benefits
Role & responsibilities 3 to 7+ years of experience in testing Healthcare system integrations, including Health Edge, Health Rules Payer (HRP), and claims management systems. Strong expertise in developing and executing End-to-End test strategies for integration projects. Experience in integration testing, regression testing, and system testing across multiple healthcare platforms. Familiarity with risk management in testing, including identifying,assessing, and mitigating testing risks. In-depth experience with environment management for testing, ensuring environments are prepared for integration and validation. Strong knowledge of EDI, HL7, and healthcare claims processes. Proven experience in defect tracking, test reporting, and utilizing test management tools. Lead end-to-end QA efforts for HealthRules Payer implementations and upgrades Collaborate with cross-functional teams to define test strategies, plans, and automation frameworks Ensure compliance with healthcare regulations and business requirements Act as the SME for HRP capabilities, configurations, and workflows Preferred candidate profile Extensive experience in QA for healthcare payer systems, especially HealthRules Payer Testing Strong understanding of claims processing, benefits configuration, and provider management Excellent leadership, problem-solving, and communication skills Experience with test automation tools and agile methodologies a plus
Role & responsibilities Following up on outstanding claims: Contacting insurance companies and patients to inquire about the status of unpaid claims and identify reasons for non-payment. Resolving payment discrepancies: Investigating and resolving issues related to incorrect payments, denials, or underpayments. Maintaining accurate records: Documenting all communication with insurance companies and patients, including follow-up actions and payment information. Working with billing and coding teams: Collaborating with other departments to identify and resolve billing errors or coding issues that may be affecting reimbursement. Ensuring compliance: Adhering to company policies and procedures, as well as relevant healthcare regulations. Providing patient support: Answering patient inquiries about their accounts and assisting with payment arrangements. Skills Required: Strong communication skills: Ability to effectively communicate with insurance companies, patients, and internal teams. Problem-solving skills: Ability to identify and resolve billing and payment issues. Attention to detail: Ensuring accuracy in documentation and claim follow-up. Knowledge of medical billing and coding: Understanding of medical terminology, CPT codes, and insurance procedures. Proficiency in relevant software: Experience with billing systems and other healthcare software. Customer service skills: Ability to handle patient inquiries and provide support. In essence, AR callers are crucial for ensuring the financial health of healthcare providers by efficiently managing accounts receivable and maximizing revenue collection. Preferred candidate profile Good English communication . Male graduates willing to work in Night shift US timings . Own bike is mandatory
Role & responsibilities Minimum of 2 years of experience in Medical Record Review Experience in processing Narrative summaries must Excellent attention to detail and analytical skills Strong communication and interpersonal skills to work with healthcare professionals Ability to work independently and manage time efficiently Preferred candidate profile This is a full-time Hybrid role located in Chennai for a Medical Record Reviewer (Work from Office/Remote ) The Medical Record Reviewer will be responsible for reviewing and analyzing medical records to ensure completeness, accuracy, compliance, and appropriateness for patient care. The Medical Record Reviewer will also coordinate with physicians, nursing staff, and other healthcare professionals to verify that the correct actions were taken to comply with policies, procedures, and regulations.
Role & responsibilities The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare, and Marketplace lines of business. This includes direct management of internal teams and external vendors handling both first-pass and second-pass recovery efforts. The role requires experience across a wide range of subrogation case typesincluding automobile-related claims (e.g., no-fault/PIP), workers compensation, general liability, medical malpractice, and mass tortwith the ability to manage and optimize recoveries across all applicable third-party liability scenarios. Key Responsibilities Oversee subrogation operations, including internal teams and multiple vendor partners managing first-pass and second-pass recovery efforts. Direct the identification, pursuit, and resolution of subrogation cases across a broad spectrum of liability types. Develop and maintain policies, workflows, and escalation protocols to support efficient and compliant subrogation operations across Medicaid, Medicare, and Marketplace populations. Collaborate with legal, claims, provider relations, finance, and compliance departments to ensure coordination and alignment on recovery efforts. Monitor case outcomes and vendor performance to ensure recovery goals are met or exceeded. Conduct regular quality assurance reviews of subrogation case files and provide coaching or corrective action as needed. Analyze trends in recoveries and provide recommendations to improve operational effectiveness and financial performance. Lead training, coaching, and development of subrogation staff to maintain high performance and technical knowledge. Prepare performance dashboards, recovery reports, and operational updates for senior leadership. Preferred candidate profile 5+ years of experience in healthcare subrogation or legal recovery, including direct oversight of multiple subrogation case types. 3+ years of experience in a leadership or management role, including responsibility for both internal staff and vendor oversight. Experience working within a Managed Care Organization (MCO) or health plan environment. Proven ability to manage complex vendor relationships and recovery strategies (e.g., first-pass and second-pass vendor models). Strong understanding of federal and state regulations related to subrogation, including HIPAA, Medicaid TPL requirements, and CMS guidelines. Excellent analytical, negotiation, communication, and team leadership skills.
Role & responsibilities Selected trainees Will be trained on Claim adjudication process They will evaluate and processes claims in accordance with company policies and procedures per CMS guidelines/SOP Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication Exercises good judgment and remains knowledgeable in related company policies and procedures Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing Gain knowledge of Commercial, Medicaid, Medicare & TPA claims processing guidelines Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc. Knowledge of different providers payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.) preferred Pay or deny per the guidelines/SOP Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols Flexibility with shift according to client need is mandatory He/She will report to Team Lead Fresher with good analytical and communication can attempt for Trainee Preferred candidate profile Fresher who can work in NIGHT SHIFTS ( US Shift timings ) Company transport not available Perks and benefits ESI and PF benefits
FIND ON MAP