Health Claims Specialist iAssist Innovations Labs

2.0 - 6.0 years

0 Lacs

chennai, tamil nadu

On-site

You are a detail-oriented and experienced Health Claims Specialist who will be responsible for accurately processing and adjudicating medical claims. Your duties will also involve providing customer service to internal and external stakeholders. Your responsibilities will include reviewing and analyzing medical claims submitted by healthcare providers to ensure accuracy, completeness, and compliance. You will need to verify patient eligibility, insurance coverage, and benefits, as well as assign appropriate medical codes (e.g., ICD-10, CPT) to diagnoses, procedures, and services. Adjudicating claims based on established criteria, including medical necessity and coverage limitations, will be a key part of your role. In addition, you will be expected to investigate and resolve discrepancies, coding errors, and claims denials through effective communication. It is essential to document all claims processing activities, decisions, and communications accurately and comprehensively in the designated database. Ideally, you should have a Bachelor's degree in fields like B.A.M.S, B.U.M.S, B.H.M.S, M.B.B.S, B.D.S, or a related field. A minimum of 2-3 years of experience in healthcare claims processing, medical billing, or health TPA is preferred. Proficiency in medical coding systems (e.g., ICD-10, CPT) and claims processing software platforms, as well as a strong understanding of healthcare insurance policies, cashless claims methodologies, and regulations, are also required for this role.,

Posted 1 day ago

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Health Claim Specialist - Internship Role PAN India iAssist Innovations Labs

0.0 - 4.0 years

0 Lacs

hisar, haryana

On-site

You are a fresher who will be gaining experience in Health Claims by undergoing a few days of training. Your main responsibility will be to accurately process and adjudicate medical claims in compliance with company policies, industry regulations, and contractual agreements. In this role, you will review and analyze medical claims submitted by healthcare providers to ensure accuracy, completeness, and adherence to insurance policies and regulatory requirements. You will also verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement. Assigning appropriate medical codes such as ICD-10 and CPT to diagnoses, procedures, and services according to industry standards will be a crucial part of your job. Additionally, you will adjudicate claims based on established criteria like medical necessity and coverage limitations to ensure fair and accurate reimbursement. It will be your responsibility to process claims promptly and accurately using designated platforms. You will investigate and resolve discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internal teams. Collaboration with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication will be essential. To excel in this role, you should maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and best practices in claims processing. Providing courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding claim status, inquiries, and appeals is also expected. Documenting all claims processing activities, decisions, and communications accurately and comprehensively in designated systems or databases is a key part of the job. Participation in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall performance is encouraged. Ideally, you should have a Masters/Bachelors degree in Nursing, B.Pharma, M.Pharma, BPT, MPT, or a related field. Excellent analytical skills with attention to detail, accuracy in data entry, and claims adjudication are essential. Effective communication and interpersonal skills, the ability to collaborate across multidisciplinary teams, and interact professionally with external stakeholders are required. You should possess a problem-solving mindset with the ability to identify issues, propose solutions, and escalate complex problems as needed. A commitment to continuous learning and professional development in the field of healthcare claims processing is crucial for success in this role.,

Posted 1 week ago

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