Executive-Claims Management-Medical Billing and Claims Processing

• Responsible to reprice the non-par claims as per the Fee schedule and payment methodology.


• Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language.


• Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information.


• Provide input for new process development and continuous improvement.


• Supplier will share daily production report with stateside manager for review and feedback.


• Maestro Health will provide all applications and accesses required for claim repricing.


• Access requests should be completed within first week of project start date in order to start production.


• Requirement gathering & training session will require active participation from Maestro Health manager.

Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier.

Skills Required:

• Graduate with good written and oral English language skills


• Expertise in using Claim processing and validation application and worked in past on same profile/portfolio.


• Basic level proficiency on Excel to query production data and prepare/generate reports.


• Analytical mindset with strong problem solving skills.


• US Healthcare insurance domain experience desirable


• Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes.

Graduate in stream preferred science stream 1 - 2 Years

Understand PMS and client PMS systems: Familiarity with Property Management Systems (PMS).
RCM Payment Posting: Experience with both manual and electronic payment posting, accounts receivable (AR), correspondence, and denial capture.
Thorough understanding of US Healthcare RCM: Expertise in payment posting, AR, correspondence, and denial capture within the US healthcare revenue cycle management.