Claims Process Executive

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1. Think bigger

   – because you have the time, opportunity, and support it takes to dig deeper and tackle larger issues.

2. Move faster

   – because you’ll be working with experienced, helpful teams who can guide you through challenges, quickly resolve issues, and show you new ways to get things done.

3. Go further

   – because you have the opportunity to grow professionally, add new skills, and take on new responsibilities in an organization that takes a long-term view of every relationship.

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Outcomes, Quality, Ownership, Accountability, and Communication

Experience Level:

Role Overview:

For Contact Duration of 6 Months

We are seeking a detail-oriented and analytical Claims/Denials Executive with 1-3 years of experience to join our team. In this role, you will be responsible for reviewing and processing claims for medical services rendered, ensuring accuracy and compliance with regulations. Your primary goal will be to minimise claim denials through a thorough review and timely resolution.

What You'll Do

As part of the job, you will be required to

Claim Processing:

• Review and analyze incoming claims for accuracy, completeness, and adherence to insurance guidelines.
• Verify patient information, procedures performed, and provider details against documentation.
• Ensure all necessary documentation is included with each claim to facilitate timely processing.
• Enter claim information into the system accurately and efficiently.

Denials Management:

• Investigate and resolve claim denials by reviewing claim details, policy terms, and medical necessity requirements.
• Identify trends in claim denials and work with relevant stakeholders to address root causes.
• Appeal denied claims when appropriate, ensuring all necessary documentation and information is provided.
• Develop strategies to reduce the frequency of claim denials through process improvement and education.

Communication

• Communicate effectively with insurance companies, healthcare providers, and patients regarding claim status and resolution.
• Collaborate with internal teams, including billing specialists and healthcare professionals, to gather information and resolve issues.
• Provide excellent customer service by addressing inquiries and concerns related to claims processing promptly and professionally.

Compliance and Reporting:

• Ensure compliance with regulatory requirements and company policies throughout the claims processing and denial management processes.
• Maintain accurate records of claims processed, denials resolved and appeals filed.
• Generate reports on claim status, denial rates, and resolution of outcomes for management review.

What We're Looking For

Must have technical skills

• Knowledge of medical billing codes (ICD-10, CPT) and insurance claim submission processes.
• Proven experience in medical claims processing, denial management, or related fields.
• Failiarity with healthcare regulations and compliance standards (HIPAA, CMS guidelines).
• Strong analytical skills with attention to detail and accuracy.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a team environment.
• Proficiency in using computer systems and software applications for claims processing.

Good to have skills

• Experience with electronic health records (EHR) systems.
• Knowledge of healthcare reimbursement

Work Environment

• Remote-First Culture: At

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  bridge, we all work from wherever we choose but come together during set hours to collaborate. Using simple online tools, we stay connected and get great work done.
• Work-From-Workweek (WWW): Twice or thrice a year, we come together for One-week sprints to collaborate in person, foster stronger team bonds, and align on goals. All travel expenses are covered in the form of allowance which is called as work week allowance.
• We organize city-wise, company-sponsored local meetups—fun-filled day outings with your colleagues!
• At

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  bridge, you get reimbursed for approved certifications and short courses that support your role.
• We embrace diversity and ensure equal opportunity for everyone, fostering an inclusive workplace where all voices are valued.

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