Quality - Sme

1 week ago

Indore Madhya Pradesh, India Star Secutech pvt ltd Full time

**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.

**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

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