Executive-Claims Management-Medical Billing and Claims Processing

Role Overview: You will be responsible for conducting primary and secondary reviews of medical claims to ensure accurate reimbursement calculations aligning with self-funded benefit plan language. Utilize Microsoft Office tools to create letters, explanations, and reports to clarify medical reimbursement methods. Your input will be valuable for enhancing processes and driving continuous improvement. You will need to share daily production reports with the stateside manager for evaluation and feedback. Maestro Health will equip you with the necessary applications and access for claim repricing. It is essential to complete access requests within the first week of the project start date to commence production smoothly. Your active participation in requirement gathering and training sessions is crucial. Key Responsibilities: - Conduct primary and secondary reviews of medical claims to verify accurate reimbursement calculations - Utilize Microsoft Office products to generate letters, explanations, and reports - Provide input for new process development and continuous improvement - Share daily production report with stateside manager for review and feedback - Ensure completion of access requests within the first week of project start date - Participate actively in requirement gathering & training sessions Qualifications Required: - Graduate with proficient written and oral English language skills - Experience using Claim processing and validation applications in a similar role - Basic proficiency in Excel for querying production data and generating reports - Strong analytical mindset with problem-solving skills - Desirable experience in the US Healthcare insurance domain - Understanding of US Healthcare system terminology, claims, complaints, appeals, and grievance processes,