Claims Adjudication

2 days ago

Pune, Maharashtra, India Mdi Networx Full time ₹ 5,50,000 - ₹ 7,50,000 per year

Key Responsibilities:

  • Adjudicate medical, dental, and vision claims using the Facets platform.
  • Review and analyze claims for eligibility, provider contracts, coding accuracy, and payment rules.
  • Ensure timely and accurate processing of claims per regulatory and organizational standards (e.g., CMS, HIPAA).
  • Identify discrepancies or issues in claims data and take corrective actions.
  • Apply plan benefit designs and provider fee schedules during claim review.
  • Collaborate with cross-functional teams including customer service, provider relations, and medical management.
  • Participate in audits and quality checks to ensure process accuracy.
  • Maintain confidentiality and compliance with data protection standards.

Required Skills & Qualifications:

  • 1 to 3 years of experience in healthcare claims adjudication.
  • Hands-on experience with Facets claims processing system is mandatory.
  • Knowledge of CPT, ICD-10, and HCPCS coding standards.
  • Familiarity with Medicare/Medicaid or commercial insurance claim guidelines.
  • Strong analytical and problem-solving skills.
  • Proficient in MS Office applications (Excel, Word, Outlook).
  • Excellent written and verbal communication skills.
  • Ability to work independently as well as in a team-oriented environment.

  • Senior Associate

    1 week ago

    Pune, Maharashtra, India Talenta Manpower Services Full time ₹ 4,00,000 - ₹ 8,00,000 per year

    We are Hiring Claims Adjuster/Adjudicator US Insurance domainLocation-Viman Nagar(Pune)Experience-3+Years of experience Candidates can applySalary-Max 8LPA(Decent hike on last CTC)Shifts-(US)ShiftsNotice Period -Up to 60Days Contact

  • Quality Engineering Specialist

    7 days ago

    Pune, Maharashtra, India Global Infovision Private Limited Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Role:Quality Engineering Lead/ Senior ConsultantLocation:Bhubaneswar, Pune, HYD, CHN, BLRJob Type: Work from officeClient: DirectMin Years of experience in end-to-end process of Provider Enrollments/ Insurance Credentialing, Provider Contracting, and Re-Credentialing.Knowledge of provider credentialing and its direct impact on the practice's revenue...

  • Quantity Surveyor

    1 week ago

    Pune, Maharashtra, India DAMAC Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    Roles and ResponsibilitiesOversee post-contract management, including claims processing and dispute resolution.Ensure compliance with FIDIC contracts and handle variations effectively.Manage procurement process from vendor registration to final deliveryConduct quantity surveying activities during pre-bid meetings and post-tender stagePrepare BOQ, tender...

  • Senior Analyst_Health Asia Flex

    1 week ago

    Pune, Maharashtra, India Mercer Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    We are seeking a talented individual to join our Insurance Operations team at Mercer. This role will be based in Pune. This is a hybrid role that has a requirement of working at least three days a week in the office.Senior Analyst – Insurance Operations (Grade B2)What can you expect?We are looking to hire a Senior Analyst in the Healthcare Claims...

  • Lead Software QA Engineer

    2 days ago

    Pune, Maharashtra, India SS&C Technologies Full time ₹ 8,00,000 - ₹ 24,00,000 per year

    As a leading financial services and healthcare technology company based on revenue, SS&C is headquartered in Windsor, Connecticut, and has 27,000+ employees in 35 countries. Some 20,000 financial services and healthcare organizations, from the world's largest companies to small and mid-market firms, rely on SS&C for expertise, scale, and technology.Job...

  • Credit Collections Senior Executive

    2 weeks ago

    Pune, Maharashtra, India Medtronic Full time ₹ 6,00,000 - ₹ 12,00,000 per year

    At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world.A Day in the LifeMedtronic is expanding their footprint for Diabetes Care with a center in Pune and as the Credit...

  • Credit Collections Senior Executive

    2 weeks ago

    Pune, Maharashtra, India Medtronic Full time ₹ 8,00,000 - ₹ 12,00,000 per year

    At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world.A Day in the LifeMedtronic is expanding their footprint for Diabetes Care with a center in Pune and as the Credit...

  • Credit Collections

    5 days ago

    Pune, Maharashtra, India Medtronic Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world.A Day in the LifeMedtronic is expanding their footprint for Diabetes Care with a center in Pune and as the Credit...

  • Associate Vice President

    3 weeks ago

    Pune, Maharashtra, India, Maharashtra Credence Global Solutions Full time

    Job Role & Responsibilities:1. Training Strategy and Leadership: • Develop and implement a company-wide training and development strategy aligned with business objectives, client needs, and industry best practices.• Oversee the design, delivery, and continuous improvement of training programs for new hires, existing employees, and leadership teams in the...

  • Director - Training (RCM)

    1 week ago

    Pune, Maharashtra, India Credence Resource Management Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    Job Role & ResponsibilitiesTraining Strategy and Leadership:Develop and implement a company-wide training and development strategy aligned with business objectives, client needs, and industry best practices.Oversee the design, delivery, and continuous improvement of training programs for new hires, existing employees, and leadership teams in the RCM BPO...