Claims Adjudicator I
1 month ago
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference _working_ in everything from scrubs to jeans.
Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.
We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
Job Description: Claims-Adjudicator I
Essential Functions:
- Basic understanding on US health insurance claims (CMS-1500 & UB04) adjudication. Providing strong analytical skills to review inpatient and outpatient facility claims with multiple and bilateral surgical services, complex anesthesia services, other professional services, preauthorization requirements, high dollar claims, DME, third-party liability and coordination of benefits.
- Assist and present knowledge share information with team members as needed.
- Responsible for adjudicating claims to maintain/comply with Service Level Agreements
- Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures.
- Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.)
- Ability to resolve claims that require adjustments and adjustment projects.
- Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
- Maintain productivity goals, quality standards and aging timeframes.
- Contribute positively as a team player.
- Complete special projects as assigned.
- Comply with all departmental and company Policy and Procedures
Education and Experience:
- Associate or bachelor's degree preferred.
- Experience in US health insurance claims processing with a minimum of 0 to 3 years adjudication experience.
- HMO Claims or managed care environment preferred.
Skills:
- Ability to work in a team environment.
- Integrity and discretion to maintain confidentiality of members, employee and physician data.
- Knowledge of medical billing and coding
- Knowledge of health insurance, HMO and managed care principles
- Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products.
- Excellent interpersonal, oral and written communication skills
- Strong attention to detail and organization
- Able to work independently, strong analytic skills.
- Strong computer skills
Mandatory Requirements:
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
-
Claims Executive
5 months ago
Mumbai, Maharashtra, India Tresbien HR Staffing Full timeGreetings! Urgently required Claims Executive for a Insurance Co. Location - Vidyavihar-Mumbai Exp - 1 Year Qualification - Any Graduate ( TPA experience Only apply) Job Profile - Should have knowledge of Cashless claims processing, required TPA Experience only Adjudication of claims on technical basis. - Computing of non-admissible items as per policy...
-
Healthcare Claims Examiner
3 weeks ago
Pune, Maharashtra, India Mphasis Full timeJob Description: As a Healthcare Claims Examiner at Mphasis, you will play a vital role in ensuring the accuracy and efficiency of healthcare claims processing.Key Responsibilities:Review and process medical claims according to established guidelines and turnaround time frames.Adjudicate claims by approving or denying them according to established...
-
Claim Administrator
2 months ago
Mumbai, Maharashtra, India Assurant Full time**This position is responsible for the delivery of exceptional customer service through claims review as per SLA.** - Adjudicate each claim with available details of defect & estimates. Collect, verify and analyse information obtained during the claims process used in settling claims to ensure that claims are valid and that settlements are made according to...
-
Claims Processing Executive
5 months ago
Airoli, Navi Mumbai, Maharashtra, India Buzzworks Business Services Pvt Ltd Full timeJob description We are Hiring for a Top MNC Company!!! **Position ; Us Healthcare Claim process** **Shift timing : Night Shift - US shift** **Work from Office (Both way cab facilities available)** **Salary: 19k CTC (Take Home - 14K)** **Location: Airoli, Navi Mumbai** - The Healthcare Operations vertical helps our clients drive breakthrough growth by...
-
Knowledge Specialist
4 days ago
Pune, Maharashtra, India Mphasis Full timeCompany Overview:Mphasis is a leading digital transformation company that helps businesses navigate the complexities of an ever-changing landscape.Salary: $55,000 - $65,000 per annumJob Description:We are seeking an experienced Claims Resolution Expert to join our team in Mphasis. As a Claims Resolution Expert, you will play a critical role in ensuring...
-
Claims Admin
2 weeks ago
Mumbai, Maharashtra, India Assurant Full time**Claims Administrator, Assurant-India** This position is responsible for effective management of claims from the time of intimation through closure with the goal of achieving target SLAs and delivering exceptional customer service. Key duties include oversite in assignment of a service network partner to each claim, confirming customers receive...
-
Insurance Claims Adjuster
4 weeks ago
Pune, Maharashtra, India Allianz Full timeJob Title: Insurance Claims AdjusterAs an Insurance Claims Adjuster, you will be responsible for investigating and resolving insurance claims in a fair and timely manner. Your primary goal is to ensure that policyholders receive the compensation they are entitled to, while also minimizing losses for the insurance company.Key Responsibilities:• Conduct...
-
Associate
3 months ago
Pune, Maharashtra, India Allstate Full timeAt Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing...
-
Medi Claims Investigation Doctor
6 months ago
Vidyavihar, Mumbai, Maharashtra, India Tresbien HR Staffing Full timeGreetings from Tresbien HR! Hiring! Urgently required Doctors -Health Claims Investigator. TPA Co - Health Insurance. Exp - 3 Years + Location - Vidyavihar, Mumbai (1 Minute walking from station) Qualification - MBBS, BAMS, BHMS, BDS Note - "TPA Doctors only apply" Job Profile - Ø Responsibility of Pan India Investigation Operations & controlling &...
-
Cashless Process
6 months ago
Vidyavihar, Mumbai, Maharashtra, India Healthindia Insurance TPA Services Pvt. Ltd. Full timeCompany Name - Healthindia Insurance TPA Location - Vidyavihar, Mumbai Role - Claim Executive Role & Responsibilities: - Adjudication of claims on technical basis. - Computing of non-admissible items as per policy wordings. - Approval of final claim payable amount with remark for deduction. Required Experience of Claim Processing in TPA...
-
Us Health Insurance
2 months ago
Navi Mumbai, Maharashtra, India INTEGRUM OUTSOURCE SOLUTIONS PVT LTD Full time**ORG. NAME **DECTREE INFOTECH PVT LTD **DEPTARTMENT**:Operations **TITLE **Claims Examiner **STATUS**:Full-time **REPORTS TO**:Team Manager **JOB SUMMARY/ORGANIZATIONAL IMPACT**:To work for US based client health insurance claims operations department. Determining insurance coverage; examining and resolving medical claims; documenting actions;...
-
Medical Officer
5 months ago
Maroshi, Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full timeParamount is presently servicing more than 50 lakh lives managing Corporate and Individual Policies and an additional 4 crores lives managing State Government Health Policies. Recipient of 'TPA of the Year' award for two consecutive years at the India Insurance Summit & Awards (2018 & 2019) We are hiring doctors for medi - claim processing hence medically...
-
Medical Officer
6 months ago
Maroshi, Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full timeParamount is presently servicing more than 50 lakh lives managing Corporate and Individual Policies and an additional 4 crores lives managing State Government Health Policies. Recipient of 'TPA of the Year' award for two consecutive years at the India Insurance Summit & Awards (2018 & 2019) We are hiring doctors for medi - claim processing hence medically...
-
Medical Officer
6 months ago
Andheri East, Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full timeParamount is presently servicing more than 50 lakh lives managing Corporate and Individual Policies and an additional 4 crores lives managing State Government Health Policies. Recipient of 'TPA of the Year' award for two consecutive years at the India Insurance Summit & Awards (2018 & 2019) We are hiring doctors for medi - claim processing hence medically...
-
Medical Officer
6 months ago
Andheri East, Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full timeParamount is presently servicing more than 50 lakh lives managing Corporate and Individual Policies and an additional 4 crores lives managing State Government Health Policies. Recipient of 'TPA of the Year' award for two consecutive years at the India Insurance Summit & Awards (2018 & 2019) We are hiring doctors for medi - claim processing hence medically...
-
Medical Officer
5 months ago
Andheri East, Mumbai, Maharashtra, India Paramount Healthcare Management Pvt Ltd Full timeParamount is presently servicing more than 50 lakh lives managing Corporate and Individual Policies and an additional 4 crores lives managing State Government Health Policies. Recipient of 'TPA of the Year' award for two consecutive years at the India Insurance Summit & Awards (2018 & 2019) We are hiring doctors for medi - claim processing hence medically...
-
Tpa
5 months ago
Borivali, Mumbai, Maharashtra, India Manki Job Staffing Services Full time**Job Overview**: **TPA**: **Mumbai**: - Job Location:Borivali - Experience:1-2 years - Salary: 18,000 - 25,000 - Job Type:Full Time - Work Location:Work From Office - No of vacancies:1 **Required Skills**: *Access to real-time eligibility and claims history reports *Accounting Support and Reconciliation *Billing Services *Eligibility Management &...
-
Tpa Executive
6 months ago
Chembur, Mumbai, Maharashtra, India ClaimBuddy Technologies Pvt Ltd Full time**Job Designation-: Insurance TPA, Medical Officer/ Claim Specialist** **Roles & Responsibilities-**: - Provide Medical opinion for Health Insurance Claims - Processing of Cashless Requests & Health Insurance Claim Documents - Proficient with medical terms & system. - Understanding of Policy terms & conditions & Various Protocols / Guidelines -...
-
Account Executive Pune
2 months ago
Pune, Maharashtra, India Soham Group Full time1. Bank Reconciliation 2. Updating Daily transaction sheet 3. Book Accessories sale In Tally 4. Bike Sale & Purchase Book in Tally 5. Spare Sale & Purchase Book in Tally 6. Accessories & Bike Audit 7. Spare Part Warranty Handling 8. Ledger Reconciliation I. Bike Ledger II. Spare Part Ledger 9. Revolt Claims I. Bike Sale Claims II. Spare Part...
-
Vacancy for Medical Officer
6 months ago
Mumbai, Maharashtra, India Robust Healthcare Solutions Full timeProcessing of cashless/reimbursement claim - Proper scrutiny of the medical documents received from the hospital/ patient and ask for relevant details to corroborate with the available diagnosis. - Review the treatment details/ medication regimen given during hospitalization and ask for justification from treating doctor if treatment protocol is not...