GM - Health Claims - Hyderabad, Telangana

Role Summary · Key Accountabilities/ Responsibilities · Stakeholder interfaces · Experience · Education · ...

Manage overall health and accident claims processes across India. Manage various external stakeholders like all TPAs with whom we have engaged to service our policies, hospital relations etc. ...

We are seeking skilled professionals to process health claims verify automated decisions and ensure every claim meets the highest standards of accuracy and compliance. · Process health insurance claims using the HealthPay platform and closely review AI-generated outcomes. · ...

The role involves leading a team in health claims management with expertise in Health Insurance and products. · ...

* Processing of Cashless Requests & Health Insurance Claims for TPA / Insurance company · * Process and Provide Medical opinion for Health Insurance Claims · * Understanding of Claims adjudication / Claims Processing · ...

We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service. · Medical Review & Claims Adjudication: · Assess and validate medical claims based on clinical documentation and policy coverage. · ...

Evaluate and process health insurance claims in accordance with policy terms and conditions. Identify and flag potential cases of medical abuse or discrepancies in treatment protocols. Determine claim eligibility based on thorough review of medical documentation and policy guidel ...

About Plum is an employee insurance and health benefits platform focused on making health insurance simple accessible and inclusive for modern organizations. · Patient Assistance Provide in-person support to insured members and families during hospitalization Verify network hospi ...

· for an insurance client , we are currently looking for a Business Analyst (m/f/d) for Claims Management. · Key details: · Project start: January 2026 · Workload: Fulltime · English-skills required · Role Summary: · Owns design and documentation of claims processing workflows, ...

Support healthcare insurance operations with focus on claims processing & customer service reviewing investigating & processing insurance claims in line with defined process guidelines & service level agreements. · ...

We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accu ...

Manage payment posting process from claim submission to reimbursement. Ensure accurate cash postings and denial management. · ...

Hiring multiple positions in AR Callers for medical billing in US health Care Domain. · ...

We are hiring for experienced AR calling roles requiring minimum 1+ years of experience in medical billing revenue cycle management knowledge of insurance guidelines medical terminology cpt icd-10 coding hipaa confidentiality guidelines effective communication skills for phone co ...

Liaison with client Product Owner/SMEs to gather functional requirements · Need to have hands-on experience with PEGA Smart Claims Engine [SCE] · Design a functional solution approach of the stories, together with the Solution Architect and Lead System Architect(s) · Participate ...

This is a full-time on-site role for a Licensed Insurance Surveyor – Non-Motor located in Hyderabad. · The primary responsibilities include assessing insurance claims for non-motor sectors, · performing thorough inspections and preparing accurate reports for clients. ...

The Accounts Receivable Specialists are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. · ...

We are looking for a Senior Business Analyst with experience in US Healthcare IT products to work on Payment Integrity/Claims Audit functions. The ideal candidate will have at least 12+ years of IT product development experience and strong knowledge of security and privacy standa ...

We are looking for Subject Matter Expert/Senior Business Analyst on US Healthcare IT products, · with specific focus on Payment Integrity/ Claims Audit functions.Work with the product owner in defining and driving product strategy and roadmap for products. · Candidate should be a ...

End-to-end Medical claim submission correction and follow-up. · ...