...Title : Sales Manager - B2B Sales - Social Enterprise Start Up Company : Human Factor (Disability Inclusion & HR Consulting services) About Us : Human Factor is a socially conscious start-up dedicated to making a positive impact on society in the Disability Inclusion space....
...Medical Adjudicator
- Manage the adjudication of prescription orders
- Conversion of inbound request into completed orders
- Coordinate the scheduling and fulfillment of diagnostic tests and procedures prescribed by healthcare providers
- Workflow Optimization...
...data review, central coding, data technology, dataset delivery, adjudication coordination, archiving and decommissioning. The Clinical Data... ...(collectively “Lilly”) are committed to help individuals with disabilities to participate in the workforce and ensure equal opportunity...
...Experienced:
3 - 5 years of experience in Dental claims adjudication
Technical Skills
· Computer navigation skills... ...conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status...
...among CAP Solutions. Besides delivering 90%-97% first-pass auto-adjudication rates and 99%+ accuracy, it enables our customers to react... ...reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in...
...have project experience in working around (any 3-5):
o Claims Adjudication & Reimbursement
o Member Enrollment
o Benefits... ...race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or...
...IN-TN), India (IN).
Roles and Responsibilities:
Process Adjudication claims and resolve for payment and Denials
Knowledge in handling... ..., gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic...
...Strong logical and analytical ability, to identify anomalies and adjudicate alerts.
Required Qualifications, Skills and Capabilities... ...expression, age, marital or veteran status, pregnancy or disability, or any other basis protected under applicable law. We also make...
Rs 16.3 lakh p.a.
...technical units for completed documentation on technical assessment, adjudication report and terms of reference including budgetary estimates... ...respect. The WHO recruits and employs staff regardless of disability status, sex, gender identity, sexual orientation, language, race...
...GenAI for Health Use Cases will be added
advantage
• Should have project experience in working around (any 2-5):
o Claims Adjudication & Reimbursement
o Member Enrollment
o Benefits Administration
o Utilization/Care Management
o Clinical Operations
o...
...Calls - Added Advantage
P&C Insurance
Experience includes processing First Notice of Loss (FNOL), Claims Settlement and Claims Adjudication
Claims experience in Property and Casualty.
Property Damage, Motor Damage, Bodily Injury
Personal lines, Commercial lines...
...the Noida office
Senior Analyst
What can you expect?
We are looking to hire a Senior Analyst in the Healthcare Claims Adjudication and email enquiries Team. The role will be responsible for processing & validating the claims adjudication of medical claims for the...
...Surveillance / Monitoring
• Sound understanding of Sanctions, PEP and other watch list which is required to perform core job for alert adjudication in accordance with bank’s policies
• Ability to independently research, analyze, and recommend solutions to close open items...
...hospital contracts & taking appropriate action basis that
• Referring cases to various department like HCS, TMT, Triage after adjudication as and when required
• Identify any over charge, ineligible chargers, contract compliance, Provider or Member Fraud
Qualifications...
...Roles and Responsibilities:
Process Adjudication claims and resolve for payment and Denials
Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
Knowledge of healthcare insurance policy concepts including in network, out of network...
Rs 5 - 10 lakhs p.a.
...Prosecuting/defending litigations by or against the company, regulatory adjudications, enquiry proceedings, statutory actions and investigations.
Engagement, briefing and coordination with external counsels for conducting Court cases.
Research and evaluation different...
...skills with ability to foresee issues and suggest solutions, with impactful data
• Excellent written & verbal communication skills with the ability to communicate clearly at all levels within the organization.
• Claims assessment & adjudication experience desired....
...business delivery & performance as per set SLA parameters of Disability claim process in Healthcare & insurance domain. And must understand... ...+ years of experience as teamlead, preferably in Indexing and Adjudication of claims.
~ Excellent communication, team management, and...
Rs 7 - 12 lakhs p.a.
...Water Dept./H.E. Dept. To obtain survey remarks like underground water line /sewage lines, High tension lines, gas lines
~ To obtain adjudication of documents, Registration work, Stamp Duty, Interaction with Legal, Construction, Architecture, and Consultants, and Govt. Degree...
...Medium
US Timings
English
1 - 2 Years of experience in US Healthcare and in Benefit Configuration - Benefit coding / Auto Adjudication Set up processes.
Experience on Facets tool will be preferred.
Excellent US Healthcare knowledge in Benefits coding and validation...
Rs 1 - 3 lakhs p.a.
...disposal, Settlement, and claim inventory as per defined process
? Being updated with policy terms and conditions to ensure prudent adjudication of claims.
? Attention to detail with regards to the identification of fraud triggers in day-to-day claim processing.
? Ensure...
...Insurance
Experience- 12+ yrs
Required Skillset
Relevant experience of handling general insurance claims related tasks
(FNOL,Adjudication,Subrogation etc.)
Knowledge of the insurance principles and applied experience
Soft Skills Good communication skills –...
...and operations & maintenance phase
Support configuration team with triage & root cause analysis of Medicaid claims and encounters adjudication results
Experience with Requirement Traceability Matrices.
Preferred experience working with HP Application Lifecycle...
...implementing large scale enterprise applications.- Strong understanding of Medicare Advantage Plans and with prior knowledge of Auto Adjudication process of Claims- Experience with US healthcare and understands the entire Ecosystem of Onboarding a Member till Adjudication-...
Rs 40 - 60 lakhs p.a.
...Essential Duties and Responsibility-
Prosecute and defend all litigations by or against the company, handle all regulatory adjudications, enquiry proceedings, statutory actions, and investigations.
• Engage, brief and coordinate with external counsels for conducting...
...Handle departmental audits, enquiries, and similar interventions.
Preparing replies for show cause notices and representing before adjudicating authorities for SCN Handle assessments and appeals on various GST matters across India.
Draft submissions in relation to audit,...
...Revenue Cycle Management (RCM), Denial Prediction Engine, POS Collection, Liability Estimation, AR Decision Support Tools, Real-time Adjudication, & more.
Clinical Support Solutions: Suite of clinical support services that help providers deliver better clinical outcomes,...
...patient accounts in accordance with the practice’s policies. This position is responsible for interpreting how a medical claim was adjudicated by patient’s health insurance and interpreting and explaining to the patient why there is a balance on their account. This position...
...procedure and constantly innovating and improvising on the processes & plans for closing assignments
Appearances and arguments before adjudication and appellate authorities up to the Tribunal. Develop and maintain an effective working relationship with the tax authorities...
...MANAGER 8L to 14 Lakhs
MANAGER 12L to 18 Lakhs ++
Responsibality :-
Responsible for setting up FNOL
Adjudication of limited threshold
Receiving queries over phone relating to Express claims
Submit payment via cheque/bank transfers...