Health Claim Specialist
4 weeks ago
Job Description: We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring timely processing claims for healthcare services rendered, maintaining high standard of accuracy and efficiency in claims processing and providing exceptional customer service to internal and external stakeholders. Pls fill this form, this is mandatory step Responsibilities: Review and analyze medical claims submitted by healthcare providers for accuracy, completeness and compliance with insurance policies and regulatory requirements. Verify patient eligibility, insurance coverage and benefits to determine claim validity and appropriate reimbursement. Assign appropriate medical codes (e.g ICD -10, CPT ) to diagnoses, procedure, and services according to industry standards and guidelines. Adjudicate claims based on established criteria including medical necessity, coverage limitation, ensuring fair and accurate reimbursement. Process claims promptly and accurately using designated platforms Investigate and resolve discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internals teams. Collaborate with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication. Maintain up to date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing. Provide courteous and professional customer service to policyholders, healthcare providers, and other stakeholder regarding claim status, inquiries and appeals. Document all claims processing activities, decisions, and communications accurately and comprehensively in the designated systems or databases. Participate in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall performance. Job Description: Bachelor’s degree like, B.A.M.S, B.U.M.S, B.H.M.S, M.B.B.S, B.D.S, or a related field preferred. Minimum of 1-2 years of experience in healthcare claims processing, medical billing, or health insurance administration. Proficiency in medical coding systems (e.g, ICD-10 , CPT) and claims processing software platforms Strong understanding of healthcare insurance policies, cashless claims methodologies, and regulatory requirements. Excellent analytical skills with attention to detail and accuracy in data entry and claims adjudication. Effective communication and interpersonal skills with the ability to collaborate across multidisciplinary teams and interact professionally with external stakeholders. Demonstrated ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment. Problem solving mindset with the ability to identify issues, propose solutions, and escalate complex problems as needed. Commitment to continuous learning and professional development in the field of healthcare claims processing. @Everyone as mandatory step please fill in the google form.
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Health Claim Specialist
4 weeks ago
Chennai, India iAssist Innovations Labs Full timeJob Description: We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...
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Urgent: Health Claim Specialist
4 weeks ago
Chennai, India iAssist Innovations Labs Full timeJob Description: We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...
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Accounts Receivable Specialist
2 days ago
Chennai, Tamil Nadu, India Ventra Health Full time ₹ 2,00,000 - ₹ 4,00,000 per yearOverviewThe Accounts Receivable ("AR") Specialists are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Specialists are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing...
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Claims adjuster
4 days ago
Chennai, Tamil Nadu, India BlueMoon Construction Full time ₹ 43,20,000 - ₹ 54,04,800 per yearAge limit: 20 to 30.Investigate Claims: Gather facts and evidence, such as police reports, witness statements, and surveillance video, to understand the details of a claim.Evaluate Policies: Review the claimant's insurance policy to determine the extent of coverage and the company's liability.Assess Damages: Inspect damaged property, vehicles, or businesses...
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Claims Operations Manager
2 weeks ago
Chennai, Tamil Nadu, India SKD HEALTH ALLIED SERVICES Full time ₹ 9,00,000 - ₹ 12,00,000 per yearAbout the CompanySKD Health Allied Services is a reputed organization and a pioneer in the industry of claims investigations across south India and Maharashtra, having its offices at Chennai , Bangalore , Ernakulam , Madurai, Hyderabad and PuneNeed talented, experienced doctors and para medics for the role of claims manager, who has a responsibility of...
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Claims Investigations Manager
2 weeks ago
Chennai, Tamil Nadu, India SKD HEALTH ALLIED SERVICES Full time ₹ 9,00,000 - ₹ 12,00,000 per yearAbout the CompanySKD Health Allied Services is a reputed organization and a pioneer in the industry of claims investigations across south India and Maharashtra, having its offices at Chennai , Bangalore , Ernakulam , Madurai, Hyderabad and PuneNeed talented, experienced doctors and para medics for the role of claims manager, who has a responsibility of...
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Accounts Receivable Specialist
5 hours ago
Guindy, Chennai, Tamil Nadu, India VENTRA Health Full time ₹ 2,50,000 - ₹ 5,00,000 per yearAbout Us:Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions...
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Health Insurance
1 week ago
Chennai, Tamil Nadu, India Expleo Full timeOverview: Health Insurance QA - UW, Claims and Finance knowledge **Responsibilities**: **Quality Assurance in Underwriting**: - Review underwriting decisions to confirm they align with risk assessment protocols. - Collaborate with underwriters to refine risk evaluation processes.**Claims Management**: - Monitor and audit claims processing to ensure...
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Online Claims Executive
2 days ago
Saligramam, Chennai, Tamil Nadu, India DIVO TV PRIVATE LIMITED Full timePerson is responsible for protecting the exclusive content of the company and its clients in all social media platforms such as YouTube, Facebook, Instagram ect. You will work closely with our content creators to identify and resolve any copyright issues that may arise. She/he is responsible for management of the Digital Assets of the company and to ensure...
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Claim Adjudication
4 days ago
Chennai, India TekWisen Software Pvt. Ltd Full timePosition: BPO Claim Adjudication(US Healthcare) Experience: 1-4years Notice period: 0-45days Skills: Must have experience in Claims Adjudication Good Exposure on COB and HIPAA **Salary**: ₹100,000.00 - ₹300,000.00 per year **Benefits**: - Cell phone reimbursement - Health insurance - Provident Fund - Work from home Schedule: - Night...
