Us Health Insurance
2 months ago
**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; maintaining client parameters.
**PLEASE NOTE - **_**Work experience in TPA, Pharmacy and other sectors will be considered as fresher. Only experience in US healthcare will be preferred**_**.**
**RESPONSIBILITIES/ ESSENTIAL FUNCTIONS**:
- Ability to analyze, review and adjudicate provider claims
- Resolves medical claims by approving or denying documentation; calculates benefit amounts due; initiates payment and/or composes denial letter.
- Ensures the legal compliance of client policies, procedures, and guidelines, as well as legal compliance with state and federal regulations during the claim process.
- Review claims to determine if costs were reasonable and/ or medically necessary.
- Report over-payments, underpayments and other irregularities to supervisor.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Be able to integrate knowledge as a skilled specialist to solve problems and find new efficient workflows.
- Protects operations by keeping claims information confidential; must be HIPPAA compliant.
- Recognize areas of weakness, provide suggestions, and update documentation for process improvement.
- Perform general and administrative duties as assigned.
**REQUIRED QUALIFICATIONS**:Abilities**
- **Typing**: Minimum 30 WPM typing speed.
- **Communication** : Ability to speak clearly, This includes customer needs assessment, so others can understand you. Meeting quality standards for services, and evaluation of customer satisfaction**. **Problem Sensitivity. Ability to forecast process risk.
- **Written Expression**. The ability to designing forms, and other office procedures communicate information and ideas in writing and terminology. so others will understand. Skills
- **Active Listening**. Giving full attention during training & OJT phase, taking time to Possess deep domain knowledge in understand the points being made, asking Healthcare and Insurance domain questions as appropriate, and not interrupting at inappropriate times.
- **Service Orientation**. Actively looking for experience such as provider contract ways to help people development, healthcare claims analysis, medical billing/coding, patient accounting,
- **Critical Thinking**. Using logic and claims auditing, and/or revenue cycle reasoning to identify the strengths and improvement required. weaknesses of alternative solutions, conclusions or approaches to problems. Must have demonstrated experience and knowledge of healthcare claims processing
**Preferred additional Knowledge**:
- In depth knowledge of Standard claim forms - UB04, UB92, HCFA.
- Sound understanding in medical billing terminologies.
**AUTHORITY**
This position does not have the authority; neither express nor implied, to legally bind the Company to any contract without written, documented consent of an Officer of the Company.
**SPECIAL JOB DIMENSIONS**:
**ADHERENCE**:
Employee must adhere/comply with all company's Policies.
**PHYSICAL REQUIREMENTS AND WORK ENVIRONMENT**
While performing the duties of this job, the employee is regularly required to sit for long periods of time and must have the dexterity of hands and fingers to operate a computer keyboard, mouse, and other office equipment. The employee must have visual acuity to read and draft reports, memos, letters, etc. Specific vision abilities required by this job include vision adequate for the incumbent to perform the responsibilities and functions of the job efficiently. Must be able to hear, speak and communicate clearly.
The employee will work in smoke-free office surrounding; noise level is quiet to moderate.
The qualifications, physical demands and work environment described herein are representative of those an employee will encounter and must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed in this document are the minimum levels of knowledge, skills and abilities.
Pay: ₹18,000.00 - ₹25,000.00 per month
**Benefits**:
- Leave encashment
- Provident Fund
Schedule:
- Day shift
- Night shift
Supplemental Pay:
- Performance bonus
- Shift allowance
Ability to commute/relocate:
- Seawoods, Navi Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (required)
Application Question(s):
- Ready to work in Seawoods Navi Mumbai
Shift availability:
- Night Shift (required)
Work Location: In person
Expected Start Date: 01/11/2024
-
Corporate Sales Account Manager
7 days ago
Mumbai, Maharashtra, India ManipalCigna Health Insurance Company Ltd Full timeAbout UsManipalCigna Health Insurance Company Ltd. is a joint venture between the Manipal Group and Cigna Corporation, offering comprehensive health insurance plans to individuals, employer-employee groups, and non-employer-employee groups.We are committed to providing quality healthcare services and insurance coverage to our customers through a range of...
-
Insurance Executive
6 months ago
Malad, Mumbai, Maharashtra, India Religare Health Insurance Full timePOLICYBAZAAR.COM health insurance MOTOR INSURNCE **Salary**: ₹18,000.00 - ₹24,000.00 per month Schedule: - Day shift **Experience**: - 6 MONTHS: 1 year (required) Ability to Commute: - Malad, Mumbai, Maharashtra (required) Ability to Relocate: - Malad, Mumbai, Maharashtra: Relocate before starting work (required) Work Location: In...
-
Health Insurance Advisor
1 month ago
Mumbai, India CKP Insurance Brokers Private Limited Full timeRoles and ResponsibilitiesGenerate leads for Selling Health Insurance Products through tele calling and field sales.Converting Leads and achieving monthly targetsDeveloping relationships with the existing clients and follow up for renewal closure.Acquiring new business for Insurance products (Corporte & Retail)Follow up with Insurance companies for...
-
mumbai, India ManipalCigna Health Insurance Company Ltd. Full timeAbout the CompanyAt ManipalCigna we resonate your commitment to your family’s health and well-being through a range of comprehensive Health Insurance plans. ManipalCigna Health Insurance Company Limited (formerly known as CignaTTK Health Insurance Company Limited) is a joint venture between the Manipal Group, a leader in the field of healthcare delivery...
-
Mumbai, India ManipalCigna Health Insurance Company Ltd. Full timeAbout the CompanyAt ManipalCigna we resonate your commitment to your family’s health and well-being through a range of comprehensive Health Insurance plans. ManipalCigna Health Insurance Company Limited (formerly known as CignaTTK Health Insurance Company Limited) is a joint venture between the Manipal Group, a leader in the field of healthcare delivery...
-
Health Insurance Sales Professional
2 weeks ago
Mumbai, Maharashtra, India CKP Insurance Brokers Private Limited Full timeJob OverviewCareer Opportunity with CKP Insurance Brokers Private Limited: We are seeking a skilled and results-driven Health Insurance Sales Professional to join our team.The ideal candidate will have a deep understanding of health insurance products, excellent communication skills, and the ability to generate leads through telecalling and field sales.Key...
-
mumbai, India ManipalCigna Health Insurance Company Ltd. Full timeAbout the Company At ManipalCigna we resonate your commitment to your family’s health and well-being through a range of comprehensive Health Insurance plans. ManipalCigna Health Insurance Company Limited (formerly known as CignaTTK Health Insurance Company Limited) is a joint venture between the Manipal Group, a leader in the field of healthcare delivery...
-
mumbai, India ManipalCigna Health Insurance Company Ltd. Full timeAbout the CompanyAt ManipalCigna we resonate your commitment to your family’s health and well-being through a range of comprehensive Health Insurance plans. ManipalCigna Health Insurance Company Limited (formerly known as CignaTTK Health Insurance Company Limited) is a joint venture between the Manipal Group, a leader in the field of healthcare delivery...
-
Health Insurance Sales Professional
2 weeks ago
Mumbai, Maharashtra, India CKP Insurance Brokers Private Limited Full timeAbout Us:CKP Insurance Brokers Private Limited is a leading insurance brokerage firm that specializes in providing tailored insurance solutions to individuals and businesses.Job Summary:We are seeking an experienced Health Insurance Sales Professional to join our team. As a key member of our sales team, you will be responsible for generating leads,...
-
Health Insurance Sales Specialist
4 weeks ago
Mumbai, Maharashtra, India CKP Insurance Brokers Private Limited Full timeRoles and ResponsibilitiesGenerate leads for selling health insurance products through telecalling and field sales, converting leads and achieving monthly targets, developing relationships with existing clients for renewal closures, and acquiring new business for insurance products.Key Requirements:Complete understanding of health insurance products,...
-
Health Insurance Sales Specialist
2 weeks ago
Mumbai, Maharashtra, India CKP Insurance Brokers Private Limited Full timeAbout CKP Insurance Brokers Private Limited">Our company is a leading insurance broker, and we're looking for a skilled Health Insurance Sales Specialist to join our team.Key Responsibilities:">">Generate leads for selling health insurance products through telecalling and field sales.">Convert leads and achieve monthly targets.">Develop relationships with...
-
Health Insurance Sales Professional
2 weeks ago
Mumbai, Maharashtra, India CKP Insurance Brokers Private Limited Full timeJob OverviewWe are seeking a skilled Health Insurance Sales Professional to join our team at CKP Insurance Brokers Private Limited. As a key member of our sales team, you will be responsible for generating leads, converting sales, and building strong relationships with clients.ResponsibilitiesDevelop and execute strategies to generate new business leads...
-
Health Insurance Product Sales Specialist
3 weeks ago
Mumbai, Maharashtra, India CKP Insurance Brokers Private Limited Full timeAbout CKP Insurance Brokers Private LimitedWe are a leading insurance brokerage firm with a strong presence in the market. Our team is committed to delivering exceptional service to our clients and partners.Job OverviewThis role offers an exciting opportunity for a skilled professional to join our team as a Health Insurance Product Sales Specialist. The...
-
Insurance Sales Executive
6 months ago
Chandivali, Mumbai, Maharashtra, India Coverfox Insurance Broking Full timeThe role is to initiate, enable and conclude health insurance sales for customers as a telecaller through the call/contact centre setup. The incumbent will report to the Team Leader for the vertical. We are seeking a dedicated and motivated Tele caller to join our team, responsible for driving insurance sales, specifically in the areas of motor and health...
-
Bdm Health Insurance
3 weeks ago
Mumbai, Maharashtra, India SM Group Full time**Job Overview**: This position involves recruiting and managing a network of Agency Partners and freelance advisors to drive health insurance sales. The individual will focus on empowering Agency Partners and insurance advisors through training, performance monitoring, and achieving business targets. This role also includes sales execution, distributor...
-
Retail Relationship Manager
3 weeks ago
mumbai, India CKP Insurance Brokers Private Limited Full timeWe are seeking a highly motivated and experienced Retail Relationship Manager - Insurance Life, Health to join our team. As a Relationship Manager Insurance you will play a critical role in driving the growth of our Retail business. You should have excellent English language skills, in-depth knowledge of Health, Life and other similar insurance products,...
-
Health Insurance Executive
2 months ago
Mumbai, Maharashtra, India Healspan Full timeAdminister health insurance policies, ensuring accurate implementation and adherence to CGHS guidelines. - Oversee the claims submission and processing workflow, ensuring timely and accurate handling of claims. - Provide assistance to beneficiaries regarding their health insurance queries, claims, and services. - Maintain and analyze data related to claims,...
-
Retail Relationship Manager
2 weeks ago
Mumbai, India CKP Insurance Brokers Private Limited Full timeWe are seeking a highly motivated and experienced Retail Relationship Manager - Insurance Life, Health to join our team. As a Relationship Manager Insuranceyou will play a critical role in driving the growth of our Retail business. You should have excellent English language skills, in-depth knowledge of Health, Life and other similar insurance products, and...
-
Retail relationship manager
2 weeks ago
Mumbai, India CKP Insurance Brokers Private Limited Full timeWe are seeking a highly motivated and experienced Retail Relationship Manager - Insurance Life, Health to join our team. As a Relationship Manager Insurance you will play a critical role in driving the growth of our Retail business. You should have excellent English language skills, in-depth knowledge of Health, Life and other similar insurance products,...
-
Retail Relationship Manager
3 weeks ago
Mumbai, India CKP Insurance Brokers Private Limited Full timeWe are seeking a highly motivated and experienced Retail Relationship Manager - Insurance Life, Health to join our team. As a Relationship Manager Insurance you will play a critical role in driving the growth of our Retail business. You should have excellent English language skills, in-depth knowledge of Health, Life and other similar insurance products,...
