Executives

Job Description

Job Description – Process Executive Position Title Executive, Medbill Adjudication Function, Responsibility Level Operations, Executive Reports to Assistant Manager, Adjudication Span of Control Nil Location Noida Permanent/ Temporary Permanent Adjudication associate is responsible for timely and accurate payment of Medical Bills submitted by US based hospital and doctors. The process includes claim adjudication, checking compensability, invoice review and the validation of the details in other systems and determine/decide on the accuracy of the amount billed and/or the need for denial of the claim based on result of research. Associate would also need to liaise with claims handlers on need basis. Essential Functions Ensure that the process transactions are processed as per Desktop procedures Ensure that the assigned targets are met in accordance with SLA and Internal standards Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence Ensure adherence to established attendance schedules Managing calendars and e-mails Performance parameters Productivity Quality / Accuracy Attendance Schedule Adherence Any other essential function that may occur from time to time as directed by the Supervisor Primary Internal Interactions AM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support. Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance CCEs (Team Members) for the purpose of seeking cooperation & clarification on process-related matters & providing assistance and support when required Subject Matter Expert for the purpose of work thread related issues and escalated transactions QCA for the purpose of feedback and audit Trainers for the purpose of Pre-process and Process training Primary External Interactions Escalation teams at the client end for the purpose of seeking clarifications & answering queries SME / Trainers at the client end for training Organizational Relationships Reports To: Assistant Manager Supervises : Nil Skills Technical Skills Good Computer navigation skills Good keyboarding speed MS Office proficiency Process Specific Skills Knowledge about the US Workers’ Comp. Insurance industry Knowledge about US Culture Soft Skills (Minimum) Good written skills Customer Service Focus Team work/ Managing Self / Adaptability Data gathering ability/ Eye for detail Soft Skills (Desired) Self disciplined and result oriented Ability to multi task Education Requirements Graduation (any stream) or diploma with a minimum of 15 years of education. Work Experience Requirements 0 to 6 year of professional experience in data entry with Insurance industry. Familiarity with workers’ compensation insurance or health insurance industry required. Experience in handling insurance claims will be added advantage along with knowledge of US Healthcare system. Show more Show less