medical claims processor

DAMANA

<div>
 
 At Damana Insurance, we are looking for a nurse/doctor by education with experience in
 
 medical coding
 
 to join our TPA in Bahrain as a Medical Claims Processor.
 
 
 
 
 
 The Medical Claims Processor is responsible for claims processing of UAE and non-UAE markets. This includes electronic claims, manual paper claims and reimbursement claims. As a Claims Processor, you will be required to analyze a claim based on policy conditions, regulatory requirements, international medical guidelines and internal process and procedures.
 
 
 
 
 
 
 Key Responsibilities:
 
 
 
 
 
 <ul>
 <li>
 Data entry / Medical review claims that are assigned in CMS at batch level or claim level as the case may be.
 </li>
 <li>
 Adjudicate each claim and associated services based on coding rule (UAE market) and policy conditions that includes system driven eligibility checks, coding checks and perform medical investigations.
 </li>
 <li>
 Follow pre-approval protocols as per provider handbook.
 </li>
 <li>
 Adhere to system driven price list information for financial accuracy of the claims.
 </li>
 <li>
 Approve up to the authority matrix.
 </li>
 <li>
 Coordinate with pre-approval team and network team on a case-by-case manner where relevant for the claims adjudication.
 </li>
 <li>
 Coordinate with providers in explaining the rejections on claims.
 </li>
 <li>
 Assist Team Leader and Operations Manager in enhancing and developing the process and system.
 </li>
 <li>
 Adhere to the contents of the Operating Procedures Manual (OPM) and the Company&rsquo;s overall procedures and policies.
 </li>
 <li>
 Miscellaneous tasks within the scope of work, as assigned by the direct manager.
 </li>
 </ul>
 
 
 
 
 
 Qualifications:
 
 
 <ul>
 <li>
 Bachelor's degree in nursing or MBBS
 </li>
 <li>
 Experience and certification in medical coding is a must.
 </li>
 <li>
 1 &ndash; 2 years' experience in health insurance field preferred.
 </li>
 </ul>
</div>

Medical Claims Processor - Nurse/ Doctor

sequel technologies

Job SummaryWe are looking for a medical billing representative to join our team. This role is ideal for fresh graduates or those with up to 1 year of experience. You will help in sending claims to insurance companies and following up on payments.Key Responsibilities<ul><li>Check patient and insurance details before billing</li><li>Submit claims to insurance companies</li><li>Follow up on unpaid or denied claims</li><li>Post payments and adjustments in the system</li><li>Answer billing questions from insurance companies or internal teams</li><li>Keep patient information private and secure</li><li>Help with data entry and daily billing tasks</li><li>Report any complex issues to the team lead</li></ul>Requirements<ul><li>High school diploma or equivalent; diploma/degree in billing or healthcare is a plus</li><li>0&ndash;1 year of experience in medical billing or healthcare office work</li><li>Basic understanding of medical terms and insurance is helpful</li><li>Good attention to detail</li><li>Strong data entry and communication skills</li><li>Knowledge of MS Office; billing software experience is a plus</li></ul>Note: Apply only if you are from Chakwal and reside there with family.Job Types: Full-time, FresherApplication Question(s):<ul><li>Are you residing in Chakwal with family?</li></ul>Work Location: In person

Medical Biller - Chakwal

One Four Art

Job Title: Medical BillerLocation: Johar Town, Lahore Timings: 6:00 PM &ndash; 2:00 AM (Night Shift) Experience Required: Minimum 5+ YearsJob Overview:We are seeking an experienced and detail-oriented Medical Biller to join our team. The ideal candidate will have at least five years of hands-on experience in medical billing, insurance claims processing, and revenue cycle management. Strong communication skills in both English and Urdu are essential for this role, along with the ability to work efficiently in a fast-paced environment.Key Responsibilities:<ul><li>Manage the complete billing process for medical services, ensuring accuracy and timely submission.</li><li>Handle insurance claims, including verification, submission, and follow-ups for approvals and reimbursements.</li><li>Review and correct claim errors to prevent denials or delays.</li><li>Communicate with insurance companies, patients, and internal teams regarding billing inquiries.</li><li>Maintain detailed documentation and patient billing records.</li><li>Ensure compliance with industry regulations, coding standards, and company policies.</li><li>Monitor unpaid claims and initiate timely follow-ups to maximize revenue collection.</li><li>Collaborate with the accounts and operations teams to improve overall billing efficiency.</li></ul>Requirements:<ul><li>Minimum 5 years of proven experience in medical billing or healthcare revenue cycle management.</li><li>Strong understanding of ICD, CPT, and HCPCS coding, claim forms, and insurance guidelines.</li><li>Excellent communication skills in English and Urdu (both written and verbal).</li><li>Strong analytical and problem-solving abilities.</li><li>Ability to work the night shift (6 PM to 2 AM).</li><li>Proficiency with medical billing software, EMR systems, and MS Office.</li><li>High attention to detail, accuracy, and confidentiality.</li><li>Ability to work independently as well as part of a team.</li></ul>What We Offer:<ul><li>Competitive salary (based on experience)</li><li>Professional and supportive work environment</li><li>Opportunities for growth within the company</li></ul>Job Type: Full-timePay: From Rs100,000.00 per monthApplication Question(s):<ul><li>What is your salary expectation?</li><li>What is your notice period?</li></ul>Experience:<ul><li>Medical Billing: 5 years (Preferred)</li></ul>Work Location: In person

Medical Biller

Connect and Heal

Job Description: Adjudication Specialist Company: Connect and Heal Primary Care Pvt. Ltd. Location: Bangalore (HSR Layout) Employment Type: Full-time About Connect and Heal Connect and Heal Primary Care Pvt. Ltd. is a leading integrated healthcare services provider, committed to delivering accessible, high-quality, and technology-enabled primary care solutions. Our ecosystem brings together emergency response, telemedicine, outpatient services, corporate health, and wellness programs to improve patient outcomes and enhance organizational health. Role Overview The Adjudication Specialist will play a critical role in ensuring accurate, timely, and compliant processing of healthcare claims and cases. The role involves reviewing medical documentation, validating clinical necessity, and ensuring that claims are adjudicated as per policy, regulatory, and contractual guidelines. The individual will work closely with medical, operations, and compliance teams to uphold quality, transparency, and efficiency in the adjudication process. Key Responsibilities &#9679; Review, validate, and process healthcare claims, ensuring adherence to company policy, provider contracts, and regulatory standards. &#9679; Assess medical records and clinical documentation to confirm eligibility, coverage, and appropriateness of services claimed. &#9679; Ensure accurate coding (ICD, CPT, HCPCS) and alignment with medical necessity criteria. &#9679; Identify discrepancies, incomplete information, or potential fraud/abuse cases, and escalate where required. &#9679; Collaborate with the medical review board, doctors, and operations teams to resolve adjudication queries. &#9679; Maintain turnaround time (TAT) and service-level agreements (SLAs) for claim processing. &#9679; Document adjudication decisions clearly and consistently in the system. &#9679; Support internal and external audits by providing data and clarifications. &#9679; Recommend process improvements to enhance efficiency, reduce errors, and strengthen compliance. Required Qualifications &amp; Skills &#9679; Graduate degree in healthcare, life sciences, or related field (Nursing, Pharmacy, MBBS, BDS preferred). &#9679; 2&ndash;5 years of experience in healthcare adjudication, medical review, or claims processing. &#9679; Strong knowledge of health insurance policies, medical coding systems (ICD, CPT, DRG, HCPCS), and adjudication guidelines. &#9679; Familiarity with healthcare regulations (IRDAI, NABH, HIPAA preferred). &#9679; Excellent analytical skills with attention to detail and accuracy. &#9679; Ability to interpret clinical documentation and medical terminology. &#9679; Strong communication and documentation skills. &#9679; Proficiency in MS Office and healthcare adjudication software. Key Competencies &#9679; Integrity and compliance orientation. &#9679; Analytical and problem-solving ability. &#9679; High attention to detail with process discipline. &#9679; Ability to work under pressure and meet deadlines. &#9679; Collaboration and cross-functional communication. What We Offer &#9679; Opportunity to work with a fast-growing, innovation-driven healthcare organization. &#9679; Exposure to diverse healthcare services, technology platforms, and corporate health ecosystems. &#9679; A collaborative and learning-oriented work environment. &#9679; Competitive compensation and benefits package.Job Type: Full-timePay: &#8377;25,670.36 - &#8377;30,286.29 per monthBenefits:<ul><li>Health insurance</li><li>Paid time off</li></ul>Work Location: In person

Adjudication Specialist

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

Billing Specialist (PHP / IOP)

BLMS SMC PVT LTD

About the RoleWe are seeking a detail-oriented and experienced Medical Biller with at least 1 year of experience in medical billing and a strong understanding of Revenue Cycle Management (RCM). The ideal candidate will be responsible for ensuring accurate billing, timely submission of claims, and effective follow-up to maximize reimbursement.Key Responsibilities<ul><li>Prepare, review, and submit medical claims to insurance companies (electronic and paper).</li><li>Verify accuracy of billing data and ensure claims are compliant with industry and payer regulations.</li><li>Perform claim follow-ups, handle denials, and process appeals as necessary.</li><li>Post payments, reconcile accounts, and resolve billing discrepancies.</li><li>Maintain patient confidentiality and adhere to HIPAA compliance standards.</li><li>Collaborate with healthcare providers, patients, and insurance representatives to ensure smooth billing operations.</li><li>Generate and review aging reports to track outstanding balances.</li></ul>Requirements<ul><li>Minimum 1+ year of experience in medical billing.</li><li>Proven experience in RCM (Revenue Cycle Management) processes.</li><li>Strong understanding of CPT, ICD-10, and HCPCS coding principles.</li><li>Familiarity with electronic medical records (EMR) and billing software.</li><li>Excellent attention to detail, problem-solving, and communication skills.</li><li>Ability to work independently and meet deadlines.</li></ul>Preferred Qualifications<ul><li>Certification in medical billing or coding (e.g., CPC, CPB) is a plus.</li><li>Experience with billing systems such as Athena, Kareo, or Epic preferred.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs80,000.00 per monthWork Location: In person

IGI LIFE INSURANCE LIMITED

Job description:&middot; Evaluate medical claims including both out-patient claims and In-Hospitalization Claims under the policy terms and conditions and recommend claims for approval&middot; Handle claims from receipt of notification to settlement and take into consideration opinions of the outside Doctor's regarding the claims&middot; Correspond with clients and agents/Investigator regarding claim queries&middot; Coordinate with Accounts Department regarding claims payments&middot; Telephonic/Outdoor investigation of facts involved in claims.&middot; Monitor team reports, direct necessary action, and inform head of department regarding pertinent information&middot; Prepare the Service Quality complaint log, handle Service Quality projects and maintain claims TAT&middot; Participate in assigned claims projects as and when requiredQualifications/ Experience/ Capabilities&middot; Minimum level of Education for this job: Bachelors (medical related field preferred)&middot; Minimum Experience required for this job: 2 years in health claimsJob Type: Full-timeWork Location: In person

Officer Health Claims

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