Rt Nagar Bengaluru Karnataka Claims specialist Jobs – 155 Open Jobs Today

SPE-Claims HC
Cognizant —Bengaluru, Karnataka
- Full-time
- Remote
- Nursing
- B.Sc
- Analysis skills
- Health insurance
- Work from home
Healthcare Support Representative
XO Health Inc. —Bengaluru, Karnataka
- ₹5,00,000 - ₹15,00,000 a year
- Rotational shift
- Remote
- Spanish
- English
- Research
- Health insurance
Quick apply
Medical Claims Processor Specialist
ContactPoint 360 —Bengaluru, Karnataka
- Full-time
- English
Director, Support (Bengaluru)
GitLab —Bengaluru, Karnataka
- Full-time
- Remote
- Salesforce
- AI
- Communication skills
- Health insurance
- Paid time off
Customer Support Specialist
ContactPoint 360 —Bengaluru, Karnataka
- Full-time
- Customer service
- English
- Microsoft Office
B2B Social Listening & Engagement Specialist with strong healthcare industry knowledge
ContactPoint 360 —Bengaluru, Karnataka
- Full-time
- English
- Research
- AI
11d
Transaction Specialist - IT Mergers & Acquisitions, Finance
Solventum —Bengaluru, Karnataka
- Full-time
- Hybrid work
- Master's degree
- 12th Pass
- Business development
12d
EPCM Procurement support - Contract Administrator / Specialist
Quest Global —Bengaluru, Karnataka
- Full-time
- Microsoft Powerpoint
- Microsoft Excel
- English
Quick apply
Customer Experience Customer Success Specialist
Cisco Systems —Bengaluru, Karnataka
- Full-time
- Computer Science
- B.Sc
- Master's degree
5d
Dedicated Claims Specialist
Loop —Bengaluru, Karnataka
- Bachelor's degree
- Medical terminology
- Communication skills
Quick apply
Data Entry Specialist( Medical Billing & Claims)
ContactPoint 360 —Bengaluru, Karnataka
- Full-time
- Microsoft Excel
- English
- Data entry
Specialist - Package Implementation
LTM —Bengaluru, Karnataka
- Java
- Analysis skills
- Continuous improvement
Quick apply
Total Rewards Specialist - India
Jumpcloud —Bengaluru, Karnataka
- Full-time
- Remote
- Microsoft Excel
- English
- Windows
- Paid holidays
10d
Senior Specialist - Package Implementation
LTM —Bengaluru, Karnataka
- Salesforce
- Finance
- Travel
Quick apply
1d
Senior Contract Specialist
Mott MacDonald —Bengaluru, Karnataka
- Full-time
- Analysis skills
- Agile
- Construction experience
- Health insurance
Claims Supervisor
The Cigna Group —Bengaluru, Karnataka
- Full-time
- Microsoft Excel
- Analysis skills
- Supervising experience
Warranty Specialist
AGCO —Bengaluru, Karnataka
- Microsoft Powerpoint
- Microsoft Outlook
- Salesforce
- Health insurance
8d
Financial Plan & Analysis Specialist
Accenture —Bengaluru, Karnataka
- Full-time
- Microsoft Excel
- Microsoft Access
- SQL
Medical Documentation Specialist (India)
Commure —Bengaluru, Karnataka
- Full-time
- AI
- Medical terminology
HRIS Payroll Specialist - Implementation | Bangalore
TransPerfect —Bengaluru, Karnataka
- Full-time
- Microsoft Excel
- Analysis skills
- Bachelor's degree
Quick apply

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SPE-Claims HC

Cognizant -
Bengaluru, Karnataka

Apply Now

Job details

Full-time

Benefits

Health insurance
Work from home

Qualifications

Nursing
B.Sc
Clinical experience
Analysis skills
Bachelor's degree

Full job description

Job Summary
This role supports health care claims operations by configuring and validating claim processing on Xcelys Claims Medical and QNXT Claims Medical platforms ensuring accurate adjudication for medical claims. The specialist uses strong domain knowledge in claims and medical benefits to improve cycle time reduce errors and support a high quality member and provider experience while working remotely during day shifts.

Responsibilities
Analyze health care claims on Xcelys Claims Medical and QNXT Claims Medical systems to ensure accurate benefit application and financially correct outcomes that support timely payments and customer satisfaction.
Review claim adjudication rules and configurations for medical benefits to maintain alignment with product policies regulatory requirements and operational guidelines while minimizing rework and claim reversals.
Execute end to end testing of claims adjudication scenarios in Xcelys and QNXT environments to validate pricing logic accumulators and edits before production deployment and reduce downstream defects.
Investigate claim exceptions denials and pended items by tracing benefit setup provider data and member eligibility to identify root causes and propose sustainable corrective actions.
Collaborate with business analysts and operations teams to translate claims business requirements into clear system changes for Xcelys and QNXT that enhance processing efficiency and quality.
Perform impact analysis for configuration updates on related claim flows including coordination of benefits prior authorization and referrals to prevent unintended disruptions.
Document standard operating procedures and reference guides for recurring claims scenarios so that operations teams can resolve issues consistently and accurately.
Monitor daily claims production reports to identify processing trends error patterns and aged inventories and then recommend targeted improvements for throughput and accuracy.
Support internal quality reviews by providing evidence of claim calculations rule interpretations and configuration decisions that demonstrate compliance with audit standards.
Respond to queries from cross functional stakeholders regarding claim outcomes by explaining configuration logic benefit interpretation and applicable business rules in an accessible manner.
Assist in continuous improvement initiatives focused on automation and simplification of claims adjudication steps which help lower operational cost and enhance member outcomes.
Coordinate with technology partners for defect triage and resolution where system behavior differs from documented design and ensure that validated fixes are deployed and tracked.
Maintain current knowledge of health care claims practices codes and payer guidelines so that configuration and adjudication decisions remain aligned with industry expectations and organizational policies.

Qualifications
Apply practical experience in medical claims adjudication to interpret complex benefit structures cost sharing rules and coverage limitations in a consistent and reliable manner.
Use hands on expertise with Xcelys Claims Medical to configure validate and troubleshoot benefit rules edits and accumulators for a wide range of medical claim types.
Leverage working knowledge of QNXT Claims Medical including claim workflows plan build and pricing configurations to support stable production operations.
Demonstrate strong domain understanding of claims life cycle encompassing intake adjudication adjustments recoveries and member and provider impacts.
Communicate clearly in a remote work from home setting using collaboration tools to align with distributed teams during standard day shifts.
Exhibit analytical and problem solving skills when interpreting data reconciling claim discrepancies and recommending targeted system or process changes.
Show adaptability by learning new payer products regulatory updates and platform enhancements that influence medical claims adjudication and configuration decisions.

Certifications Required
BSc Nursing with 2-3 years of clinical experience .

Apply Now

Refine Your Search

claims specialist jobs in rt nagar bengaluru karnataka

SPE-Claims HC

Healthcare Support Representative

Medical Claims Processor Specialist

Director, Support (Bengaluru)

Customer Support Specialist

B2B Social Listening & Engagement Specialist with strong healthcare industry knowledge

Transaction Specialist - IT Mergers & Acquisitions, Finance

EPCM Procurement support - Contract Administrator / Specialist

Customer Experience Customer Success Specialist

Dedicated Claims Specialist

Data Entry Specialist( Medical Billing & Claims)

Specialist - Package Implementation

Total Rewards Specialist - India

Senior Specialist - Package Implementation

Senior Contract Specialist

Claims Supervisor

Warranty Specialist

Financial Plan & Analysis Specialist

Medical Documentation Specialist (India)

HRIS Payroll Specialist - Implementation | Bangalore

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