Quality - SME

1 week 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

  • Senior Manager

    2 weeks ago

    Indore, Madhya Pradesh, India IndiGo (InterGlobe Aviation Ltd) Full time ₹ 20,00,000 - ₹ 25,00,000 per year

    Primary Job ResponsibilitiesAchieving Revenue Targets: Ensure that the agreed targets for Agency, Corporate & SMEs are met/exceeded for the State of Chhattisgarh & Madhya Pradesh.Agency, Corporate & SME Relationships: Maintain effective relationships with key Agents, Corporates & SMEs such as high performing and potential Travel Agencies/Corporates/SMEs to...

  • Team Lead Operations

    2 weeks ago

    Indore, Madhya Pradesh, India Aegan Technologies Private Limited Full time ₹ 15,00,000 - ₹ 25,00,000 per year

    Job Title: Team Lead Operations – Claims Adjudication (US Healthcare)Location: [Indore]Experience: Minimum 4.6 years in US Healthcare Claims Adjudication, including at least 1 year as SME (on papers)Role OverviewThe Team Leader – Claims Adjudication is responsible for supervising a team of claims processors/adjudicators to ensure accurate and timely...

  • US Health Care Claims Adjudication

    2 weeks ago

    Indore, Madhya Pradesh, India Webtech Softwares Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Open Position :Team Leader OperationsQuality SpecialistSubject Matter Expert (SME)Process Trainer3.6 Years of Experience in US Healthcare Claim Processing and Adjudication Senior Talent Acquisition Shiny Hari

  • SEO/SME Executives Required

    2 weeks ago

    Indore, Madhya Pradesh, India Endeavor IT Solution Full time ₹ 3,00,000 - ₹ 9,00,000 per year

    Company Description Bestowed with high professionalism, Endeavor It solution is a Web solution provider located in Indore, India. We are professional organization committed to creating and implementing innovative solutions that help transform business. We provide services like Website Designing, Web Development, Search Engine Optimization (SEO), Ecommerce...

  • Subject Matter Expert

    2 weeks ago

    Indore, Madhya Pradesh, India Gyanohm Learning Pvt. Ltd. Full time ₹ 2,16,000 per year

    Job Opening: Subject Matter Expert in Science, Commerce, and Engineering (Hindi)Location: IndoreJob Summary:We are seeking a dynamic and innovative Subject Matter Expert (SME) to join our EdTech company Vidyaa Tech is a (subsidiary of Gyanohm Learning Private Limited). The ideal candidate will deeply understand their respective subject area of Science,...

  • Application Tech Support Practitioner

    2 weeks ago

    Indore, Madhya Pradesh, India Advent Global Solutions Full time ₹ 4,00,000 - ₹ 6,00,000 per year

    Project Role : Application Tech Support PractitionerProject Role Description : Act as the ongoing interface between the client and the system or application. Dedicated to quality, using exceptional communication skills to keep our world class systems running. Can accurately define a client issue and can interpret and design a resolution based on deep product...

  • Relationship Manager

    2 weeks ago

    Indore, Madhya Pradesh, India YES BANK Full time ₹ 15,00,000 - ₹ 25,00,000 per year

    Job Title: Relationship ManagerDepartment: Medium Enterprises (ME)Experience: 3–4 YearsGrade: Manager to AVPRole SummaryWe are looking for a dynamic and result-oriented Relationship Manager (RM) to join our Medium Enterprises (ME) team. The ideal candidate will be responsible for sourcing and managing a portfolio of clients with turnover ranging from...

  • Business Consultant- Supply Chain

    2 days ago

    Indore, Madhya Pradesh, India EdgeVantage Full time ₹ 5,00,000 - ₹ 15,00,000 per year

    We are looking for Business Consultants for an Advisory Firm, dedicated to empowering small and medium-sized enterprises (SMEs) across India with innovative solutions and strategic insights. As a forward-thinking consulting firm, they strive to help businesses navigate challenges and achieve sustainable growth. We are on the lookout for someone who has...

  • Sterile Engineer Unit Level at Indore

    6 days ago

    Indore, Madhya Pradesh, India Hector And Streak Consulting Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    Sterile Engineer Unit LevelLocation: IndoreExperience Required: 1015 years in sterile process engineering (Pharma/Biotech)Education: BE/B.Tech in Mechanical or Chemical EngineeringRole PurposeThe Sterile Engineer plays a pivotal role in supporting Unit Engineering and Operations by enhancing asset reliability, optimizing maintenance strategies, and ensuring...

  • L2 Operations, RAN

    2 weeks ago

    Indore, Madhya Pradesh, India Rakuten Symphony Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    Why should you choose us?Rakuten Symphony is reimagining telecom, changing supply chain norms and disrupting outmoded thinking that threatens the industry's pursuit of rapid innovation and growth. Based on proven modern infrastructure practices, its open interface platforms make it possible to launch and operate advanced mobile services in a fraction of the...