• Analyze payer payments to identify underpayments and reimbursement discrepancies by comparing paid amounts to contracted rates, fee schedules, and expected reimbursement • Interpret and apply payer contract terms, guidelines, and reimbursement methodologies to ensure accurate payment outcomes • Conduct detailed account analysis using strong analytical skills and persistence to resolve complex denials and payment variances • Review accounts for credit balances and denials, determine root cause, and take appropriate corrective action (refund, adjustment, rebill, or appeal) • Review and resolve credit balances across all payers, with priority on regulatory accounts (e.g., Medicare credit balance reporting) • Submit timely, accurate appeals and process credit resolutions in alignment with payer and regulatory guidelines (including Medicare credit balance requirements) • Ensure all account activity supports forward movement toward resolution with a one-touch mindset • Maintain thorough, audit-ready documentation and accurate account notes • Meet established productivity (APH) and quality standards while prioritizing high-risk, high-dollar, and timely filing accounts • Collaborate cross-functionally to resolve issues and prevent recurrence • Identify trends and escalate systemic issues, providing feedback for process improvement • Initiate and track refunds, adjustments, and reapplications accurately and timely

• Review self-pay accounts to verify insurance coverage. • Analyze and resolve unpaid claims. • Contact insurance carriers for claim status and payments. • Research claims using online tools. • Gather and submit supporting documentation to insurance carriers. • Submit appeals when necessary. • Review and apply contractual terms. • Communicate with patients/guarantors to expedite claims. • Assist with special projects and additional duties as needed. • Ensure compliance with information security policies. • Monitor inventory and provide reporting on open claims. • Report security risks as per procedures.

Role Description Ready to turn bold ideas into real-world impact? At Genpact, we don’t just adapt to change, we lead it. AI and digital innovation are transforming the way businesses work, and we’re at the forefront of it. Job Responsibilities: - Conduct actuarial analyses to evaluate and manage financial risks for insurance products. - Develop, maintain, and validate actuarial models and tools to support pricing and risk management decisions. - Analyze and interpret insurance data to generate statistical reports, forecasts, and actionable insights. - Conduct research on industry trends, emerging risks, and regulatory changes to ensure compliance and competitiveness. - Collaborate with cross-functional teams, including underwriting, finance, and claims, to inform business strategies. - Present findings and recommendations to stakeholders clearly and effectively to support decision-making. - Ensure adherence to regulatory requirements, professional standards, and internal actuarial governance processes. Qualifications - Bachelors - Actuarial Science - Bachelors - Economics - Bachelors - Finance - Bachelors - Risk Management and Insurance - Masters - Statistics Requirements - Certifications: - Associate in Claims (AIC) - The Institutes (USA) - Certified Financial Analyst (CFA) - Skillab - Certified Fraud Examiner (CFE) - ACFE - Chartered Insurance Professional (CIP) - Chartered Insurance Institute (CII) - Fellow of the Institute of Actuaries (FIA) - Institute and Faculty of Actuaries (UK) - Required Skills: - Data Analytics - Insurance - Lean Six Sigma (LSS) - Life Insurance - Reinsurance - Total Quality Management (TQM) - Language: English (Required) - Language Proficiency: Upper Intermediate - B2 - Job Type: Regular - Remote Type: Remote - Work Shift: Evening Job (India) Benefits - Lead AI-powered transformation – Drive innovation and solve real-world business challenges that matter - Make an impact – Help global enterprises solve business challenges that matter - Accelerate your career – Gain hands-on experience, mentorship, and world-class learning opportunities to stay ahead - Work with the best – Join 140,000+ bold thinkers and problem-solvers who push boundaries every day - Thrive in a values-driven culture – Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress

Role Description Inviting applications for the role of Insurance Claims Administrator - Senior Associate - French. - General administrative duties such as scanning, photocopying, profiling, issuing documentation and mailbox monitoring. - Accurate, timely and efficient data entry and quality checking of claims information as per the standards. - Open a new “account” for each claim, into the system to help with efficient processing of the claim – throughout the claim lifecycle. - Prepare the payment of claims in the system. - Process and dispatch standard letters and emails as required. - Support data cleansing and mass change processing projects. - Keep the relevant KPIs updated. - Liaising with internal and external parties to respond to and resolve queries within processing deadlines. - General contact with underwriters and clients (if applicable) always providing a great customer experience. - Preparing management information reports as requested using various reporting tools and methods. - Participate and provide support to process improvement projects. - Delivers exceptional service standards/KPIs. - Participating and support the implementation in continuous improvement or change project work. - Providing support to other teams to cover absences and peak workloads. - Contributing to technical support and procedural best practice and support. - Provide new ideas and support the team leader and coordinator regarding execution. - Ensure telephony service availability in line with defined working hours and required languages. - Answer all incoming calls received through the claims telephony lines. - Identify the nature of the enquiry and confirm whether it relates to an existing claim or a new notification. - Resolve simple customer or broker enquiries when the information is readily available in the system. - Redirect calls to the correct handler, team or department when the query cannot be resolved at first contact. - Log call details in the claim file or relevant system to maintain a clear and accurate audit trail. - Escalate urgent or risk related calls following internal escalation routes. - Manage call backs by logging the request and ensuring it is assigned or completed within required timeframes. - Monitor telephony metrics such as wait times, call volumes and abandonment, and escalate issues when service levels are at risk. Qualifications - Minimum qualifications: Economic studies (e.g. finance, accounting or similar domains) - BA. - Proficient in written and spoken Dutch (Flemish) and English. - Good interpersonal skills with the ability to work as a member of various teams. - Excellent accuracy and attention to detail and quality to produce high quality output even when dealing with high volume and under pressure. - Experience on small claims handling or in insurance will be an advantage. - Curious, willing to learn and showing a challenging conventions spirit. - Ability to organise and prioritise and plan workload to meet deadlines. - Demonstrating personal integrity; doing what they say they’ll do when they said they’d do it. - Personable, able to develop rapport easily and build relationships. - Good customer focus. Requirements - Bachelors - Actuarial Science, Bachelors - Economics, Bachelors - Finance, Bachelors - Risk Management and Insurance, Masters - Statistics. - Certifications: Associate in Claims (AIC) - The Institutes (USA), Certified Fraud Examiner (CFE) - ACFE, Certified Insurance Counselor (CIC) - American Academy of Professional Coders (AAPC), Chartered Property Casualty Underwriter (CPCU) - Insurance Institute of America (IIA). - Required Skills: Claims Management, Insurance. - Language: English, French (Required). - Language Proficiency: Advanced - C1. Benefits - Lead AI-powered transformation – Drive innovation and solve real-world business challenges that matter. - Make an impact – Help global enterprises solve business challenges that matter. - Accelerate your career – Gain hands-on experience, mentorship, and world-class learning opportunities to stay ahead. - Work with the best – Join 140,000+ bold thinkers and problem-solvers who push boundaries every day. - Thrive in a values-driven culture – Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress.