Associate - Reconciliation

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Role Summary:

The main responsibility of the role is to process claims with proper quality and to ensure the claims are paid in timely manner. The requires attention to details as the claims has already been rejected previously and is now in the reconciliation process for settlement.

Primary Responsibilities

• Evaluates and ensures that all the medical & technical claims denied or underpaid inappropriately by payers are identified, appealed and reversed as per the set deadlines.

• Maintains production goals and quality standards set by the Team Leader. Team leaders will be conducting regular audits against the standard expected level of quality and quantity.

• Ensures all claims are in compliance with coding & insurance guideline

• Maintains and achieves the target deadlines

• Provides daily feedback for rejection trends, and to avoid it in the future in order to optimize clients’ revenue, conveys such feedback to team leaders for future occurrence

• Raises queries to the team leader to get required documents

Job Requirements:

• Complete Knowledge of both HAAD & DHA Guidelines.

• Coding background IP/ OP

• Paramedical knowledge

• Claim processing

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