CLAIM ADJUDICATION

• Should possess U.S Health insurance claim processing experience
• Knowledge of medical billing and coding terminologies
• Ready to work in Night Shift as well as Day shift
• Understanding of plan documents and general benefits
• Familiarity with terms such as deductible, out of pocket, coinsurance, and copay
• Strong attention to detail and accuracy
• Ability to work in Microsoft word, Excel
• Process claims and ensure accuracy during testing of plan build
• Understand and analyze plan documents to determine benefits and coverage
• Ability to analyze, review and adjudicate provider claims
• Resolves medical claims by approving or denying documentation; calculates benefit amounts due; initiates payment and/or composes denial letter.
• Ensures the legal compliance of client policies, procedures, and guidelines, as well as legal compliance with state and federal regulations during the claim process.
• Review claims to determine if costs were reasonable and/ or medically necessary.
• Able to identify over-payments, underpayments and other irregularities in Processed claims.
• Verifying member eligibility, benefit coverage and researching or applying authorizations.
• Be able to integrate knowledge as a skilled specialist to solve problems and find new efficient workflows.
• Protects operations by keeping claims information confidential; must be HIPPAA compliant.
• Recognize areas of weakness, provide suggestions, and update documentation for process improvement.
• Perform general and administrative duties as assigned.

Job Type: Full-time

Pay: ₹18,000.00 - ₹25,000.00 per month

Experience:

• US Health Insurance: 1 year (Required)

Location:

• Navi Mumbai, Maharashtra (Required)

Shift availability:

• Night Shift (Required)
• Day Shift (Required)

Work Location: In person