claims processor

The Cigna Group

<p></p><div><p>We are looking for a detail-oriented claims Analyst Lead to join our insurance team.</p><p><br>
You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.</p><p>
To be successful, you should have excellent organizational and interpersonal skills and also be able to work under pressure and perform a range of clerical functions with great attention to detail.</p><p></p><p><b>
Context :</b> Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.</p><p></p><p><b>
Main Duties / Responsibilities :
</b></p><ul><li>A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.</li><li>
Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.</li><li>
In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.</li><li>
Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.</li><li>
Recording and maintaining insurance policy and claims information in a database system.</li><li>
Determining policy coverage and calculating claim amounts.</li><li>
Processing claims payments.</li><li>
Answering queries related to Policy coverage criteria and guidelines.</li><li>
Complying with federal, state, and company regulations and policies.</li><li>
Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.</li><li>
Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.</li><li>
Performing other clerical tasks, as required.</li></ul><p><b><br>
Requirement :
</b></p><ul><li>Medical Qualification Background will be an added advantage.</li><li>
At least 5 years of experience as a claim or in a related role.</li><li>
Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.</li><li>
Working knowledge of the insurance industry and relevant federal and state regulations.</li><li>
Computer literate and proficient in MS Office.</li><li>
Excellent critical thinking and decision-making skills.</li><li>
Good administrative and organizational skills.</li><li>
Strong customer service skills.</li><li>
Ability to work under pressure.</li><li>
High attention to details</li></ul><p></p><p><b>
About The Cigna Group
</b></p><p></p>Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we&rsquo;re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.<p></p><p><i>
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.</i></p><p></p><p><i>
If</i><i> you require reasonable accommodation in completing the online application process, please email: </i><i>SeeYourselfEMEA@cigna.com</i><i> for support. Do not email </i><i>SeeYourselfEMEA@cigna.com</i><i> for an update on your application or to provide your resume as you will not receive a response.</i></p></div>

Claims Lead Analyst

Judah Code Technologies

<p>Key Responsibilities:</p><ul><li>Review and process healthcare insurance claims in accordance with client guidelines.</li></ul><ul><li>Verify patient, provider, and claim details for completeness and accuracy.</li></ul><ul><li>Identify and resolve discrepancies or missing information in claims.</li></ul><ul><li>Ensure timely processing of claims to meet daily productivity and quality standards.</li></ul><ul><li>Handle claim denials, rejections, and resubmissions as per standard procedures.</li></ul><ul><li>Maintain proper documentation and update internal systems with claim status.</li></ul><ul><li>Collaborate with team leads or supervisors to address process issues or escalations.</li></ul><ul><li>Adhere to HIPAA and company data security policies at all times.</li></ul><ul><li>Participate in process improvement and quality assurance initiatives.</li></ul><p>Required Skills &amp; Qualifications:</p><ul><li>Bachelor&rsquo;s degree in any discipline.</li></ul><ul><li>0&ndash;3 years of experience in insurance claims processing (healthcare preferred).</li></ul><ul><li>Good understanding of US healthcare insurance concepts (CPT, ICD, HCPCS codes preferred).</li></ul><ul><li>Excellent written and verbal communication skills in English.</li></ul><ul><li>Strong analytical and problem-solving skills.</li></ul><ul><li>Basic computer knowledge with proficiency in MS Office (Excel, Word).</li></ul><ul><li>Ability to work night shifts and meet strict deadlines.</li></ul><p>Preferred Qualifications:</p><ul><li>Experience in claims adjudication, AR follow-up, or medical billing.</li></ul><ul><li>Knowledge of EOB (Explanation of Benefits) and healthcare claim life cycle.</li></ul><ul><li>Prior experience in BPO/KPO environments.</li></ul><p>Job Type: Full-time</p><p>Pay: &#8377;14,000.00 - &#8377;16,000.00 per month</p><p>Work Location: In person</p>

Process Associate Medical Billing

NMC Health plc

<div><p>Checks and compiles ALL Insurance claims before submitting them to respective payers and insurance companies using coded data to finalize and submit claims to insurance companies.</p></div>
<br><div><p>Verify the items in the open bills according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, rate plan etc. Ensure that the bills are finalized in compliance with the contractual terms and price agreement.
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3.2 Finalize all codified credit bills for batch/statement generation based on the submission cycle (eg, weekly, monthly etc). In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc and confirm the bill.
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3.3 In the case of insurance claims, prepare the xml batch for the finalized claims and validate in the regulator&rsquo;s portal. Correct errors if any. In the case of corporate and individual payers prepare statement of claims for the period.
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3.4 In the case of Insurance claims, submit XML batches to regulator&rsquo;s portal (eg. greenrain messenger). In the case of corporate and individual payers, dispatch the claims with all documents attached and dispatched with a manual acknowledgement slip.
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3.5 In the case of pharmacy claims, check the transactions according to TPA/payer, member ID, validity of the card, coverage, approvals/LPO, insurance plan, refunded transactions etc.
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3.6 Ensure that the claims are appropriately dispatched by receiving the acknowledgement slip or verifying the regulatory post office with facility license number.
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3.7 Can prepare required monthly reports upon request.
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3.8 Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
</p><p>3.9 Comply with all OSH (Occupational safety and health )and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements
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3.10 Work accordance with the documented OSH procedures and instructions, specific responsibilities
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3.11 Be familiar with emergency and evacuation procedures
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3.12 Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports
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3.13 Comply with Waste management procedures and policies
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3.14 Attend applicable OSH/Infection control training programs, mock drills and awareness programs
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3.15 Use of appropriate personal protective equipment and safety systems
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3.16 Ensure as far as reasonably practicable that any workplaces they manage or control are safe and without risks to health, safety or the environment.
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3.17 Ensure implementation of applicable HAAD, NMCRH OSHMS and infection control policies and standards
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3.18 Ensure adequate budget and resources for FMS/OSH/PCI management.
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3.19 Designating a Safety facilitator who will be responsible for coordinating OSH activities within the department.
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3.20 Regularly discuss OSH issues or matters in departmental/ management meetings
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3.21 Ensure provision of OSH information, training and Supervision
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3.22 Implement and monitor effectiveness of risk management program</p></div>
<br><div><p>Bachelor of Commerce, Business Administration or any other degree. Paramedical or coding knowledge will be advantage.
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4.2 Two years minimum of experience.
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4.3 Knowledge of insurance billing procedure.
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4.4 Knowledge in using computer and related software applications.
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4.5 MS Office Experience, Word, Excel and Power point.
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4.6 Extreme organization skills.
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4.7 Communication, interpersonal skills as applied to interaction with co-workers, supervisor and customers</p></div>

Billing Officer

<div><div>Claims Processing Team: Submission
<br>
<ul><li>Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
</li><li>Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
</li><li>Uploads OP E-claims.
</li><li>Identifies commonly used ICD codes and relevant CPT codes and compile the list.
</li><li>Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
</li><li>Reports variations / irrelevance in the CPT codes used for services/procedures.
</li><li>Assigns proper CPT/ HCPCS codes for newly added services / procedures.
</li><li>Reports the audit findings about discrepancies in the claims daily.
</li><li>Be available to the Consultants about clarification regarding the ICD/ CPT codes.
</li><li>Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off.
</li></ul>Claims Processing Team: Resubmission
<br>
<ul><li>Coder is required to review documentation by the physicians in the UCF / E &ndash; Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
</li><li>Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
</li><li>Be available to the Consultants about any clarification regarding ICD/CPT codes.
</li><li>Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections.</li></ul></div></div>
<br><div><div>Claims Processing Team: Submission
<br>
<ul><li>Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
</li><li>Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
</li><li>Uploads OP E-claims.
</li><li>Identifies commonly used ICD codes and relevant CPT codes and compile the list.
</li><li>Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
</li><li>Reports variations / irrelevance in the CPT codes used for services/procedures.
</li><li>Assigns proper CPT/ HCPCS codes for newly added services / procedures.
</li><li>Reports the audit findings about discrepancies in the claims daily.
</li><li>Be available to the Consultants about clarification regarding the ICD/ CPT codes.
</li><li>Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off.
</li></ul>Claims Processing Team: Resubmission
<br>
<ul><li>Coder is required to review documentation by the physicians in the UCF / E &ndash; Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
</li><li>Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
</li><li>Be available to the Consultants about any clarification regarding ICD/CPT codes.
</li><li>Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections.</li></ul></div></div>
<br><div><p>Bachelor/Diploma/High School</p></div>

RCM Officer - UAE National

<div><ul><li><div><p>The Resubmission Officer will be responsible for filing and tracking insurance claims, process insurance and disability claims in a timely manner.
</p></div></li><li><div><p>Process the Resubmission of rejected claims on the system, follow up with respective doctors for justification if necessary and prepare them for resubmission.
</p></div></li><li><div><p>Ensure that all concerned teams such as Patient Admin staff, coders, doctors are updated on time with the rejections and corrective action is taken to avoid such instances in future.
</p></div></li><li><div><p>Submit the claims with proper codes and format to insurance companies within the stipulated time.</p></div></li></ul></div>
<br><div><ul><li><div><p>The Resubmission Officer will be responsible for filing and tracking insurance claims, process insurance and disability claims in a timely manner.
</p></div></li><li><div><p>Process the Resubmission of rejected claims on the system, follow up with respective doctors for justification if necessary and prepare them for resubmission.
</p></div></li><li><div><p>Ensure that all concerned teams such as Patient Admin staff, coders, doctors are updated on time with the rejections and corrective action is taken to avoid such instances in future.
</p></div></li><li><div><p>Submit the claims with proper codes and format to insurance companies within the stipulated time.</p></div></li></ul></div>
<br><div><p>Minimum of 1 years of experience in the Insurance Department.
</p><p>Knowledge of Claims Resubmission, Spreadsheets, and Software Modules.
</p><p>Skills in Current Procedural Terminology (CPT) Coding.
</p><p>Must have CPC certification</p></div>

Submission & Resubmission Officer

IGI LIFE INSURANCE LIMITED

<p>&middot; Evaluate medical claims including both out-patient claims and In-Hospitalization Claims under the policy terms and conditions and recommend claims for approval</p><p>&middot; Handle claims from receipt of notification to settlement and take into consideration opinions of the outside Doctor's regarding the claims</p><p>&middot; Correspond with clients and agents/Investigator regarding claim queries</p><p>&middot; Coordinate with Accounts Department regarding claims payments</p><p>&middot; Telephonic/Outdoor investigation of facts involved in claims.</p><p>&middot; Monitor team reports, direct necessary action, and inform head of department regarding pertinent information</p><p>&middot; Prepare the Service Quality complaint log, handle Service Quality projects and maintain claims TAT</p><p>&middot; Participate in assigned claims projects as and when required</p><p><i><b>Qualifications/ Experience/ Capabilities</b></i></p><p>&middot; Minimum level of Education for this job: Bachelors (medical related field preferred)</p><p>&middot; Minimum Experience required for this job: 2 years (preferably in the corporate or billing section of a hospital or in claims in an insurance firm)</p><p>Contractual position which can lead to permanent status.</p><p>Job Type: Full-time</p><p>Pay: From Rs123,456.00 per month</p><p>Ability to commute/relocate:</p><ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul><p>Work Location: In person</p>

Officer Claims

<div><p>3.1 Review and Audit Medical Claims to ensure their accuracy.
</p><p>3.2 Resubmission of rejected claims
</p><p>3.4 Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
</p><p>3.5 Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
</p><p>3.6 Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
</p><p>3.7 Submit the claims with proper codes and format to insurance companies within the stipulated time.</p></div><p></p>
<br><div><ul><li>Review and Audit Medical Claims to ensure their accuracy.
 </li><li>Resubmission of rejected claims
 </li><li>Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
 </li><li>Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
 </li><li>Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
 </li><li>Submit the claims with proper codes and format to insurance companies within the stipulated time.</li></ul></div>
<br><div><ul><li>Medical/Nursing graduate from a recognized university.
</li><li>Experience in Insurance Claims Resubmission
</li><li>Experience in Medical Coding is preferable.
</li><li>Excellent command of oral and written English.</li></ul></div>

Medical Auditor

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