Quality - SME

Job Role: QA -Claim Adjudication

Location: Indore

Shifts: US Shift

Both the way cab available

5 Days working (Saturday & Sunday fixed off)

Salary: 5.5-6 LPA + incentives + allowance

Experience: Minimum 4.6 years of experience in claims adjudication, with at least 1 year in a SME on papers.

Key Responsibilities

• Auditing Claims: Reviewing adjudicated claims to verify the accuracy of decisions, compliance with client guidelines, and adherence to healthcare/insurance standards.

• Quality Monitoring: Tracking and analysing performance metrics, preparing reports, and sharing insights to improve the claims processing function.

• Compliance: Ensuring all processes and handling of member/provider data comply with regulations such as HIPAA.

• Collaboration: Working with operational teams to implement corrective measures and improve training programs.

• Knowledge Management: Developing and maintaining a thorough understanding of insurance policies, products, and the broader healthcare insurance industry.

Key Skills & Qualifications

• Technical Skills: Proficiency in claims adjudication systems, quality management tools (like the 7 QC tools), and methodologies like Six Sigma.

• Analytical & Problem-Solving Skills: Ability to analyze complex data, identify discrepancies, and develop effective solutions.

• Knowledge of Regulations: Strong understanding of industry regulations, insurance policies, and legal standards.

• Communication Skills: Effective communication to share insights and collaborate with different teams and stakeholders.

• Attention to Detail: Crucial for accurately verifying documentation and ensuring the completeness of claim information.

Interested candidates can call or whatsapp to 9087726632 for interview process!!!

Job Types: Full-time, Permanent

Pay: ₹450,000.00 - ₹600,000.00 per year

Benefits:

• Health insurance
• Leave encashment
• Paid sick time
• Paid time off
• Provident Fund

Education:

• Bachelor's (Required)

Experience:

• QA-Claims: 4 years (Required)

Location:

• Indore, Madhya Pradesh (Required)

Application Deadline: 15/10/2025
Expected Start Date: 13/10/2025