medical claims processor

The Cigna Group

<div>We are looking for a detail-oriented claims Analyst Lead to join our insurance team. 
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.
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.
Context : 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.
Main Duties / Responsibilities :
<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> 
Requirement :
<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>
About The Cigna Group
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.
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.
If you require reasonable accommodation in completing the online application process, please email: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.</div>

Claims Lead Analyst

Alliance Insurance Abu Dhabi

Responsibilities: Receive, review, and process medical insurance claims submitted by policyholders or healthcare providers.
Adjudicate claims based on policy terms, coverage limits, and medical necessity criteria.
Verify the accuracy and completeness of claim forms, medical records, and supporting documentation.
Investigate questionable claims by contacting healthcare providers, requesting additional information or documentation, and analysing medical records.
Make decisions on claim approvals, denials, or requests for additional information based on investigation findings and policy guidelines.
Ensure timely and accurate processing of approved claims for payment, including coordinating with finance departments and third-party administrators.
Communicate with policyholders, healthcare providers, and internal stakeholders regarding claim status, decisions, and any required actions.
Maintain detailed records of claims, correspondence, and investigation outcomes in accordance with regulatory requirements and company policies.
Ensure compliance with healthcare regulations, coding standards (e.g., ICD-10, CPT), and company policies throughout the claims process.
Provide excellent customer service to policyholders and healthcare providers, addressing inquiries and resolving issues related to claims.
 Qualification &amp; Skills: <ul>
<li>Bachelor of Medicine, Bachelor of Surgery (MBBS), Nursing degree, or relevant medical degree from an accredited institution.</li>
<li>Experience in the relevant health insurance industry is preferred.</li>
<li>Minimum knowledge of computer skills, including proficiency in Excel and other relevant software applications.</li>
<li>Strong analytical, communication, and problem-solving skills.</li>
<li>Attention to detail and ability to work efficiently in a fast-paced environment.</li>
<li>Ability to prioritize tasks and meet deadlines effectively.</li></ul>

Senior claims officer

Physicians Revenue Group

Job Title: Accounts Receivable (Medical Billing)Shift: 06:00 PM &ndash; 03:00 AMResponsibilities:<ul><li>Manage and process medical claims and insurance reimbursements.</li><li>Review and follow up on unpaid claims, ensuring timely resolution.</li><li>Verify insurance information and update patient records.</li><li>Resolve billing discrepancies and communicate with insurance companies.</li><li>Ensure compliance with healthcare regulations and policies.</li><li>Maintain accurate financial records and assist in audits when required.</li></ul>Qualifications:<ul><li>Experience in medical billing and coding.</li><li>Knowledge of insurance procedures and claim processing.</li><li>Strong attention to detail and problem-solving skills.</li><li>Excellent communication skills.</li></ul>Job Type: Full-timeApplication Question(s):<ul><li>How would you rate your communication skill out of 5?</li><li>Are you available for working at 07:oo pm to 04:00 am ?</li><li>How many years you have experience in medical Billing ?</li></ul>Education:<ul><li>Bachelor's (Required)</li></ul>Work Location: In person

Account Receivable - Medical Billing

Doctors Urgent Care Group

We are seeking an experienced Medical Biller with a strong background in Rheumatology billing and coding to join our team. The ideal candidate will have in-depth knowledge of Rheumatology-specific procedures, modifiers, infusion billing, and insurance authorizations, ensuring timely and accurate reimbursement.Key Responsibilities<ul><li>Prepare, review, and submit accurate medical claims to insurance companies (electronic and paper) for Rheumatology services.</li><li>Verify insurance coverage, obtain authorizations, and ensure claims comply with payer policies.</li><li>Review documentation for appropriate CPT, ICD-10, and HCPCS coding specific to Rheumatology (e.g., infusion therapy, biologics, joint injections).</li><li>Monitor aging reports and follow up on unpaid or denied claims promptly.</li><li>Correct claim errors, re-bill, and appeal denied or underpaid claims.</li><li>Post insurance and patient payments, process refunds, and reconcile accounts.</li><li>Communicate with patients regarding billing inquiries and outstanding balances.</li><li>Collaborate with providers and front-desk staff to ensure complete and accurate documentation for billing.</li><li>Maintain up-to-date knowledge of Rheumatology-specific coding changes, payer regulations, and compliance standards (HIPAA, CMS).</li></ul>Job Type: Full-timeApplication Question(s):<ul><li>Do you have experience working with rheumatology?</li></ul>Work Location: Remote

Medical Biller

eServMD Pvt. Ltd.

eServMD Pvt Ltd is a service provider company based in Islamabad Pakistan providing services to US-based companies and clients in the field of Electronic Medical Records (EMR), Medical Practice Management, Medical Billing, Real Estate, Accounts &amp; Finance.We are seeking experienced and detail-oriented Medical Billing Specialists to join our team.Primary Responsibilities:<ul><li>Review and process medical claims using appropriate coding and billing systems.</li><li>Verification of demographics &amp; insurance eligibility &amp; benefits.</li><li>Resolve billing discrepancies and errors in a timely manner</li><li>Maintain complete and accurate patient billing records.</li><li>Payment Postings, reimbursement &amp; collection analysis and reporting</li><li>Identify &amp; resolve billing issues, denial management &amp; claims, follow-up with insurance</li><li>Develop and manage to KPIs and dashboards for increasing client satisfaction, outcomes, and retention.</li><li>Communicate with patients and healthcare providers as needed to resolve billing issues</li><li>Stay up-to-date on insurance company billing policies and procedures</li></ul>Minimum Qualification:<ul><li>2+ years minimum experience in USA medical billing</li><li>Proficiency in medical billing software and coding systems</li><li>Strong attention to detail and problem-solving skills</li><li>Ability to work in a fast-paced, high-volume environment</li><li>Willingness to work according to USA business hours</li><li>Excellent communication skills in written and spoken English; ability to read, write, and interpret.</li><li>Must be willing to work on-site during USA business hours</li></ul>Note: Please Read job description carefully before ApplyingJob Type: Full-timeJob Type: Full-timeWork Location: In person

Sr. Medical Biller

Medi Assist Insurance TPA Private Limited

Roles &amp; Responsibilities:<ul><li>Claim Processing: Verify the medical admissibility of a claim by confirming diagnosis and treatment details.</li><li>Claim Scrutiny: Scrutinize claims according to the terms and conditions of the insurance policy.</li><li>Data Interpretation: Interpret ICD coding, evaluate co-pay details, and classify non-medical expenses, room tariffs, and capping details. Differentiate between open billing and package deals.</li><li>Process Verification: Understand the process difference between a PA and an RI claim, and verify necessary details accordingly.</li><li>Document Verification: Verify all required documents for processing claims and raise an IR (Information Request) if documents are insufficient.</li><li>Team Coordination: Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of a tariff.</li><li>Claim Approval: Approve or deny claims as per the terms and conditions within the TAT (Turnaround Time).</li><li>Communication: Handle escalations and respond to emails promptly.</li></ul>Interested candidates can share their resumes via email or WhatsApp:<ul><li>Email: abhilasha.dutta@mediassist.in</li><li>WhatsApp: 8050700698</li></ul>Job Type: Full-timePay: &#8377;335,000.00 - &#8377;430,000.00 per yearBenefits:<ul><li>Health insurance</li><li>Paid sick time</li><li>Paid time off</li><li>Provident Fund</li></ul>Application Question(s):<ul><li>What is your current CTC?</li><li>How many years of experience do you have?</li><li>What is your expected CTC?</li></ul>Work Location: In person

Consultant Medical Officer (Non-Clinical) - Mumbai

Hiffey

Claims Med pioneers in Medical Billing for Healthcare providers in the United States. We are looking for fresh, energetic individuals who can not only add value to our firm, but also find endless opportunities in a growing firm. We are currently hiring for our Medical billing/AR/Credentialing teams and looking for candidates who are willing to learn and apply themselves in a short period of time. Job Description<ul><li>Medical records evaluation</li><li>Insurance eligibility verification</li><li>Claim generation and submission</li><li>Follow-up on pending claims</li><li>Account Receivables</li></ul>Requirements<ul><li>Night shift availability (7pm to 4am)</li><li>Mondays to Fridays</li><li>Graduation (required)</li><li>English Proficiency is must</li></ul>Location Shaheed-e-Millat Rd, Karachi Paid training will be provided. Finalists will begin a 3-month probation period and will be re-evaluated before becoming permanent employees. Permanent employees enjoy several performance, and punctuality based bonuses, along with other perks. Please submit your resumes and begin your journey of becoming an integral part of the Claims Med family.Job Type: Full-timePay: Rs45,000.00 - Rs50,000.00 per monthWork Location: In person

Medical Billing Analyst(Male)

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