Quality - SME

9 hours ago

Indore, Madhya Pradesh, India Star Secutech pvt ltd Full time ₹ 7,20,000 per year

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.

Interested candidates can call or whatsapp to for interview process

Job Types: Full-time, Permanent

Pay: ₹450, ₹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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