CLAIM ADJUDICATION

As a candidate for this position, you should possess U.S. health insurance claim processing experience and have knowledge of medical billing and coding terminologies. You should be willing to work in both night shifts and day shifts with a strong attention to detail and accuracy. Additionally, you should have the ability to work in Microsoft Word and Excel. Key Responsibilities: - Process claims and ensure accuracy during testing of plan build - Understand and analyze plan documents to determine benefits and coverage - Analyze, review, and adjudicate provider claims - Ensure legal compliance with client policies, procedures, and guidelines, as well as state and federal regulations during the claim process - Review claims to determine the reasonableness of costs and medical necessity - Verify member eligibility, benefit coverage, and research or apply authorizations - Integrate knowledge as a skilled specialist to solve problems and find new efficient workflows - Maintain confidentiality of claims information and ensure HIPAA compliance - Identify areas of weakness, provide suggestions, and update documentation for process improvement - Perform general administrative duties as assigned Qualifications Required: - 1 year of experience in U.S. Health Insurance - Location: Navi Mumbai, Maharashtra - Shift availability: Night Shift and Day Shift - Work Location: In person Please note that this is a full-time position that requires the ability to work in both night and day shifts at the specified location.,