Claims Executive

Responsibilities:

1. Claims Processing Analysis:

   Conduct comprehensive analysis of claims data to identify trends, anomalies, and opportunities for improvement.

2. Quality Assurance:

   Execute quality assurance processes to verify the accuracy and completeness of claims submissions and adjudications.

3. Performance Monitoring:

   Monitor key performance indicators (KPIs) related to claims processing efficiency, accuracy, and turnaround time.

4. Root Cause Analysis:

   Investigate discrepancies or errors in claims processing, performing root cause analysis and implementing corrective actions.

5. Documentation and Reporting:

   Maintain detailed documentation of analysis findings, QA results, and corrective actions taken. Generate regular reports for management review.

6. Process Optimization:

   Collaborate with cross-functional teams to streamline claims processing workflows, eliminate inefficiencies, and enhance overall quality.

7. Compliance Assurance:

   Ensure adherence to regulatory requirements, company policies, and industry standards in all claims processing activities.

8. Training and Support:

   Provide guidance and support to sales team, offering training on best practices, system usage, and quality standards.

Qualifications:

1. Bachelor's degree in a relevant field such as Healthcare Administration, Business Administration, or Finance,1-2 years of experience in a similar role, preferably within the healthcare, insurance, or financial services industry.
2. Strong analytical skills with the ability to interpret complex data sets and draw actionable insights.
3. Proficiency in Microsoft Excel or similar data analysis tools.
4. Excellent communication skills, both verbal and written, with the ability to effectively interact with cross-functional teams.
5. Knowledge of claims processing systems and familiarity with industry-specific terminology and regulations is desirable.