medical claims manager

Macrise Tech Solutions

Key ResponsibilitiesAccounts Receivable &amp; Denials Management<ul><li>Monitor and manage outstanding insurance claims to reduce overall Accounts Receivable (AR) balances.</li><li>Review and resolve claim denials on a daily basis, ensuring prompt and accurate follow-up.</li><li>Analyze Electronic Remittance Advice (ERA) data to identify recurring denial patterns and recommend corrective measures.</li><li>Prepare, submit, and track appeals for denied or underpaid claims with appropriate documentation.</li><li>Investigate and resolve payment discrepancies, escalating complex cases to the Billing Manager as needed.</li><li>Maintain and update AR aging reports, providing regular weekly and monthly performance updates.</li><li>Process claims for specialized services, including TMS, Spravato, and psychological testing.</li><li>Collaborate closely with the Billing Manager to meet AR resolution and collection goals.</li></ul>Patient &amp; Provider Support<ul><li>Respond to billing-related inquiries from patients, providers, and internal teams in a timely manner.</li><li>Review and update patient accounts to ensure accuracy prior to initiating collection actions.</li><li>Work with providers to correct claim errors, including coding and supporting documentation.</li><li>Coordinate with insurance payers regarding prior authorizations, coverage verification, and network participation.</li><li>Address patient billing concerns professionally and process refunds where appropriate.</li></ul>System Support &amp; Process Improvement<ul><li>Submit and monitor support tickets in eClinicalWorks (eCW) to resolve billing-related issues efficiently.</li><li>Provide training and support to team members on AR and denial management workflows.</li><li>Partner with U.S.-based teams to ensure timely and accurate claim submissions.</li><li>Participate in team meetings to review AR performance, identify trends, and recommend process improvements.</li><li>Stay current with payer policies, compliance regulations, and medical billing best practices.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Insurance Claims & Denials Resolution Associate-Medical Billing

مستشفى دار الشفاء - Dar Alshefa Hospital

<div>
 <ul>
 <li>
 
 JOB SUMMARY
 
 </li>
 </ul>
 
 The insurance doctor is responsible for managing all insurance-related activities for the hospital, ensuring that medical claims are accurate, compliant, and processed efficiently to maximize reimbursement and minimize denials. It is a hybrid role combining deep clinical knowledge, insurance expertise, data analysis, team leadership, and process improvement.
 
 
 
 
 <ul>
 <li>
 
 KEY ACTIVITIES AND RESPONSIBILITIES
 
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Evaluate and process claims in accordance with insurance policy, terms and conditions, and MNGHA policies and procedures. Review medical reports and ensure proper entry and compatibility with the services provided by the hospital.
 </li>
 <li>
 Check the accuracy of medical information with supporting documents (i.e., laboratory, pharmaceutical, radiology, etc.).
 </li>
 <li>
 Communicate with the treating physician/medical team for any clarification or completion of missing information.
 </li>
 <li>
 Escalate pending cases to the concerned department and follow up directly with Medical Services. Coordinate and follow up with the approving officer(s) on discrepancies in the official form.
 </li>
 <li>
 Collaborate with the claims section team on clinical queries/requests to reassess the claims.
 </li>
 <li>
 Collaborate and communicate with insurance company representatives, such as claims adjusters or medical reviewers, to provide additional information or clarification about the medical services provided.
 </li>
 <li>
 Develop a billing system to improve Revenue Cycle Management (RCM) and decrease the number of rejections. Report any observations related to claims that may affect the RCM.
 </li>
 <li>
 Facilitate the reconciliation process, respond to rejected claims with proper justifications in accordance with the insurance requirements, and coordinate with the insurance companies for resubmission in a timely manner.
 </li>
 <li>
 Participate in establishing, developing, and implementing guidelines to evaluate and process medical claims.
 </li>
 <li>
 Assuring requires preauthorization or prior approval for specific treatments, procedures, or medications.
 </li>
 <li>
 Collect sufficient information for each issue and escalate it to the concerned department.
 </li>
 <li>
 Provide professional advice to subordinates on all aspects of medical insurance practice and law.
 </li>
 <li>
 Assume the responsibilities of Claims Analyst as and if required.
 </li>
 <li>
 Prepare and present necessary reports and correspondences as required by the Executive Management and Senior Executive Management.
 </li>
 <li>
 Perform other job-related duties.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 
 Key Result Areas
 
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Weekly/Monthly Claims Processed
 </li>
 <li>
 Coding &amp; Documentation Accuracy
 </li>
 <li>
 Query Resolution Time
 </li>
 <li>
 Reduction in Missing Information
 </li>
 <li>
 Reduction in Claim Rejection/Denial Rate
 </li>
 <li>
 Reduction in Pending Cases
 </li>
 <li>
 Discrepancy Resolution
 </li>
 <li>
 Timely Resubmission
 </li>
 <li>
 Reduction in Write-offs
 </li>
 <li>
 Timeliness and accuracy of financial reports produced
 </li>
 <li>
 Number Reporting breaches identified
 </li>
 <li>
 Consolidations, Reporting &amp; Analysis
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 
 Qualifications
 
 </li>
 </ul>
 
 
 
 
 Degree in Medicine or equivalent
 
 
 
 
 <ul>
 <li>
 
 Technical Skills
 
 </li>
 <li>
 Knowledge of CBAHI, Ministry of Health care policy and procedure.
 </li>
 <li>
 Knowledge of the health care sector.
 </li>
 <li>
 Knowledge of Medical coding, billing process and Clinical Documentation for RCM
 </li>
 <li>
 Clinical Understanding
 </li>
 <li>
 Work-stream leads, subordinates, healthcare team, physicians, insurance companies
 </li>
 <li>
 High paced environment with intense deadlines
 </li>
 <li>
 Great deal of details and accuracy
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 
 Behavioural Skills
 
 </li>
 <li>
 Attention to Detail
 </li>
 <li>
 Professional Communication
 </li>
 <li>
 Analytical Skills: Ability to analyse denial trends and identify root causes
 </li>
 <li>
 Problem-Solving: Proactive in creating solutions to prevent future claim rejections
 </li>
 <li>
 Persistence &amp; Follow-up: Tenacity in managing the appeals and resubmission process.
 </li>
 <li>
 Business Acumen
 </li>
 <li>
 Strategic Thinking
 </li>
 <li>
 Leadership Skills
 </li>
 <li>
 Ethical and Personal Integrity
 </li>
 </ul>
</div>

Insurance Doctor

Workinshrewsbury

Salary: £35k - 40k per year Reference: 70437 Are you ready to take your career to the next level as a Senior Claims Manager? This role offers the opportunity to lead and shape the claims process within a small and reputable company. With a focus on Agricultural, Commercial and Personal Lines Business, you'll play a pivotal role in ensuring claims are processed accurately and efficiently. If you're looking for a position that offers a busy role within a supportive team environment this is the role for you. What You Will Do: <ul> <li>You will be responsible for managing the entire claims process, from receipt to settlement, to ensure efficient and accurate payment of claims</li> <li>Assist clients with claims-related enquiries, providing direct support or connecting them with the right contacts.</li> <li>Work closely with insurers, loss adjusters, solicitors, brokers, and claimants to ensure claims are processed efficiently and accurately.</li> <li>Regularly chase outstanding claims and ensure prompt settlement payments to customers.</li> <li>Deliver exceptional customer service and promote top-tier customer care at all times.</li> <li>Supervise claims handlers and provide guidance and support as needed.</li> <li>Review and evaluate claims to ensure accuracy and compliance with policies and regulations</li> <li>Develop and implement policies and procedures to improve efficiency and quality of claims processing</li> </ul> What You Will Bring: <ul> <li>A minimum of 2 years' experience in a Senior Claims Management role or related field.</li> <li>Strong leadership, organisational, and communication skills to manage teams and processes effectively.</li> <li>Proficiency in Microsoft Office and claims management software.</li> <li>Exceptional attention to detail and the ability to manage multiple priorities with ease.</li> </ul> As a Senior Claims Manager, you'll be at the heart of ensuring claims are handled with diligence and professionalism. This company prides itself on delivering tailored solutions to meet the needs of its diverse client base. With a commitment to quality and customer care, you'll contribute to maintaining and enhancing its reputation in the industry. This role is perfect for someone who thrives in a fast-paced environment and is ready to take ownership of the claims process. Location: This role is based in Shrewsbury, offering a convenient and accessible location for professionals in the surrounding area. Interested? If you're ready to step into a leadership role and make a difference, don't wait! Apply now to join this company as a Senior Claims Manager and take the next step in your career journey.<img src="https://www.jobg8.com/Tracking.aspx?vX6ucqYYTObsWA55idoRV6qfQnPuhCogv" width="0" height="0" />

Claims Manager

Venn Group

Overview Locum Legal Claims Manager - 12 months - Full Time - Hybrid-Working - Up to £60 per hour - North-WestPosition: Locum Legal Claims ManagerOrganisation: North-West based OrganisationDuration: up to 12 monthsWorking Pattern: 30-37.5 hours across 4-5 days per weekWorking Arrangement: Hybrid, office attendance in the North West 2-3 days per weekHourly Rate: Up to £60 per hour Umbrella Responsibilities <ul><li>Lead and manage a team of solicitors and claims specialists, providing supervision, support, and professional development</li><li>Handle any escalations from team members</li><li>Oversee the full lifecycle of claims including public liability, employer's liability, property damage, and environmental claims</li><li>Liaise with external counsel, insurers, regulatory bodies, and other stakeholders to manage complex or high-value claims</li><li>Maintain compliance with all relevant legal and regulatory requirements, including environmental and health & safety law</li><li>Monitor trends in claims data and provide insights and reports to senior leadership, identifying areas for operational improvement or risk mitigation</li><li>Manage a small case load pertaining to the above areas</li></ul> Essential to the role <ul><li>The successful candidate must be a qualified Solicitor/Barrister/CILEx</li><li>Demonstrable experience working in a commoditised claims environment</li><li>Evidence of team management in a claims environment</li></ul> How to apply If you're interested in this Locum Litigation Lawyer position, you can apply for this role online or contact Beth Jackson-Jones directly via phone or email for further information on:Email: Phone: Job Reference: J91277 Venn Group is an equal opportunities employment business and employment agency and welcomes applications from all candidates. All rates stated serve only as a guide and all applicants will be considered on their individual merits.<img src="https://www.jobg8.com/Tracking.aspx?b3tFgLThzre43JhC9yQSpSt75NFgC%2bU0e" width="0" height="0" />

Locum Legal Claims Manager

Anzurra

Job Description Overview Our client is one of the worlds leading civil construction groups with an annual turnover exceeding 50 billion and a workforce of over 100000 employees worldwide. As a key player in global infrastructure development the company is responsible for constructing some of the worlds most prestigious projects. As the company continues to evolve they are now looking to strengthen its contract management department in the Middle East with a Claims Manager appointment. This role will focus on commercial and residential projects and it will play a key role in managing all Contract and Claims Management activities across multiple projects in Saudi Arabia. You Ideally you will have worked in Saudi Arabia or the Middle East within the international construction environment. It is a must that you have worked on largescale overseas projects including but not limited to commercial residential and data centres. As an experienced Claims Manager you will be fluent in English and ideally you will be a degreequalified quantity surveyor engineer or construction professional. Additionally you will be : <ul> <li>Capable of handling complex client and subcontractors claims.</li> <li>Manage amendments claims and revaluations defend our clients interests.</li> <li>Responsible for contractual strategy.</li> <li>Knowledgeable of common law type stakeholders (Engineer consultant client etc.</li> <li>Knowledgeable of FIDIC forms of contract.</li> <li>Experience in working with delay quantum and technical experts.</li> </ul> Who are we Anzurra is an Executive Search and Talent Consultancy specialised in Commercial Contract Management & Legal. We work inhouse with ambitious companies across the construction infrastructure and real estate markets helping them to hire and retain marketleading talent. With offices in both London and Copenhagen Anzurra works globally providing embedded ondemand and flexible recruitment solutions that help you scale to your potential. As experts in recruitment executive search and talent advisory we help power highperforming teams across the following sectors : Legal Construction Finance Real Estate Renewable Energy Contact Us For further information please reach out to Francesca Indelicato (Talent Consultant) or John Murphy (Director). Required Experience Manager Key Skills Corporate Paralegal,Baan,IT Sales and Marketing,Civil Quality Control,Activex,Jboss Employment Type : Full-Time Experience : years Vacancy : 1<img src="https://www.jobg8.com/Tracking.aspx?06jDRgHoD8KvlunkhwEEAMSLeIXWV8qSq" width="0" height="0" />

Navi

<div>
 
 
 
 About the Team
 
 
 
 
 The Process Excellence team at Navi is focused on maintaining and elevating the quality of customer interactions. As the quality audit function, the team conducts regular audits of agent communications&mdash;across calls, chats, and other channels&mdash;to ensure accuracy, consistency, and compliance. The team also ensures compliance across different verticals and runs multiple initiatives in coordination with business team stakeholders to drive key business metrics. Insights from these audits are used to drive continuous improvement through targeted training, helping agents close knowledge or process gaps and deliver a consistently excellent customer experience.
 
 
 
 
 
 
 
 About the Role
 
 
 
 
 We are seeking an experienced doctor with medical knowledge for the process excellence vertical to join our dynamic team. As a vital member of our Process Excellence team, a quality auditor dedicated exclusively to auditing claims processed by medical officers to ensure accuracy, compliance, and continual improvement. A quality auditor conducts detailed reviews of claims, identifying areas for improvement.
 
 
 
 
 
 
 
 What We Expect From You
 
 
 
 <ul>
 <li>
 The role involves identifying discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements
 </li>
 <li>
 Review health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.
 </li>
 <li>
 Identify any inconsistencies, overbilling, or discrepancies between the services provided and the claims submitted
 </li>
 <li>
 Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors
 </li>
 <li>
 Suggest process improvements to enhance the efficiency and accuracy of the claims audit process.
 </li>
 <li>
 Stay updated with industry trends, regulations, and changes in healthcare policies that may impact claims auditing.
 </li>
 </ul>
 
 
 
 
 
 
 Must Haves
 
 
 
 <ul>
 <li>
 Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
 </li>
 <li>
 Experience in handling an audit
 </li>
 <li>
 Background in claims processing with clinical experience in a hospital setting
 </li>
 <li>
 Data analytics experience would be an added advantage
 </li>
 <li>
 Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.
 </li>
 <li>
 Knowledge of health insurance policies and regulations, IRDAI circulars is a must
 </li>
 <li>
 Strong analytical and problem-solving skills.
 </li>
 <li>
 Excellent attention to detail and ability to spot discrepancies
 </li>
 <li>
 Ability to anticipate potential problems and take appropriate corrective action
 </li>
 <li>
 Effective communication skills for working with different stakeholders
 </li>
 <li>
 Time management skills to meet deadlines.
 </li>
 <li>
 Should have a broad understanding of Claims Practice
 </li>
 <li>
 Sharp business acumen to understand health insurance claim servicing needs
 </li>
 <li>
 Excellent communication skills, including writing reports and presentations
 </li>
 </ul>
 
 
 
 
 
 
 Inside Navi
 
 
 
 
 We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal &amp; Home Loans to UPI, Insurance, Mutual Funds, and Gold &mdash; we&rsquo;re building tech-first solutions that work at scale, with a strong customer-first approach.
 
 
 
 
 
 Founded by Sachin Bansal &amp; Ankit Agarwal in 2018, we are one of India&rsquo;s fastest-growing financial services organisations. But we&rsquo;re just getting started!
 
 
 
 
 
 
 
 Our Culture
 
 
 
 
 The Navi DNA
 
 
 
 Ambition. Perseverance. Self-awareness. Ownership. Integrity.
 
 
 
 We&rsquo;re looking for people who dream big when it comes to innovation. At Navi, you&rsquo;ll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you&rsquo;re driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each other&mdash;and that starts with every one of us.
 
 
 
 
 
 
 
 Why You'll Thrive at Navi
 
 
 
 
 At Navi, it&rsquo;s about how you think, build, and grow. You&rsquo;ll thrive here if:
 
 <ul>
 <li>
 
 You&rsquo;re impact-driven :
 
 You take ownership, build boldly, and care about making a real difference.
 </li>
 <li>
 
 You strive for excellence
 
 : Good isn&rsquo;t good enough. You bring focus, precision, and a passion for quality.
 </li>
 <li>
 
 You embrace change
 
 : You adapt quickly, move fast, and always put the customer first.
 </li>
 </ul>
</div>

Claims Manager - Medical Claim Audit

TIME Appointments Ltd

Time Appointments are working alongside an innovative Claims Management company who are currently recruiting for an experienced Motor Claims Manager to strengthen their UK based operations. The successful candidate will become part of a growing company who offer great routes of progression and industry qualifications to further skills and development.Please be advised that this role is 100% remote, therefore applicants must be comfortable and at ease working from home.To be considered for this fantastic opportunity, applicants are required to have experience gained from within a similar position, with a proven track record in successfully overseeing the Motor Claims Department and managing the Motor Claims Team Leaders You will also need to be fully competent in all aspects of claims management and people development, with proven influencing and problem-solving capabilities and experienced in Technical Motor Claims.As well as managing, motivating, and coaching a team of Motor Claims Adjusters, the successful Claims Manager will be involved in all aspects of Insurance Claims Handling, dealing with the full cycle of client's claims from instruction through to settlement. You will advise and update clients on how best to present their claims and will also assist them with how to negotiate with insurers to achieve the best outcome. Key Responsibilities <ul><li>Lead and manage a team of motor adjusters and team leaders handling a diverse portfolio of accounts.</li><li>Oversee larger losses and contentious cases while maintaining responsibility for an individual caseload.</li><li>Consistently achieve or exceed performance goals while effectively overcoming obstacles.</li><li>Implement and maintain best practices for claims handling, including intake, investigation, evaluation, settlement, and recovery.</li><li>Monitor and analyse claims data to identify trends, patterns, and opportunities for process improvement.</li><li>Align team operations with client and customer expectations of the claims process.</li><li>Act as an escalation point for complex or high-value claims.</li><li>Ensure accuracy and adequacy across all aspects of claim reserving.</li><li>Develop and implement strategies to mitigate fraudulent claims, ensuring compliance with legal and regulatory requirements.</li><li>Foster a positive team culture, promoting collaboration, professional growth, and development.</li><li>Drive performance management by attracting, hiring, retaining, and training top talent.</li><li>Collaborate with internal teams (Account Management, Compliance, Claim Operations) to resolve complex claims-related issues.</li><li>Build and maintain strong relationships with external stakeholders, including policyholders, agents, brokers, and legal representatives.</li><li>Prepare and deliver comprehensive claims reports, metrics, and analysis to clients, advising on claim trends and loss mitigation strategies.</li></ul> Skills & Experience required <ul><li>Chartered Institute Qualifications minimum of DIP CII or equivalent (we will consider those working towards)</li><li>10+ years in insurance claims management experience in multiple lines of business, preference for property, general liability and/or motor with bodily injury experience</li><li>5+ years management experience with preference for experience managing in a remote environment</li><li>Comfortable with technology and the ability to evolve the claims systems and processes to drive better efficiencies and outcomes</li><li>Demonstrated commitment to quality, accuracy, and attention to detail</li><li>Integrity, ethics, and a strong sense of accountability in handling confidential and sensitive information</li></ul> In return the successful candidate will receive: <ul><li>A generous and competitive annual salary</li><li>Substantial health-insurance package</li><li>Pension plan with employer contributions</li><li>Industry Qualifications paid for (after a qualifying period)</li><li>Competitive holiday / leave policy in addition to bank holidays</li><li>Regular corporate retreats to build team cohesion, reinforce culture, and have fun</li><li>All the technology you require to allow to work from home effectively and comfortably</li></ul><img src="https://www.jobg8.com/Tracking.aspx?u8CXZ0QX%2bc%2b%2fMI%2bmCbNmF4FIuRbTPRVfy" width="0" height="0" />

Motor Claims Manager (Remote)

Search 10000+ Medical claims manager jobs near you this October. New roles added regularly across leading industries. Apply today.

10000 medical claims manager jobs NEAR_ME

Insurance Claims & Denials Resolution Associate-Medical Billing

Insurance Doctor

Claims Manager

Locum Legal Claims Manager

Claims Manager

Claims Manager - Medical Claim Audit

Motor Claims Manager (Remote)