Firstsource hiring For Experienced / Healthcare Claims

1 - 6 years

1 - 3 Lacs

Posted:-1 days ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes.

We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, Mexico and India. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals.

Key Responsibilities

Claims Processing

  • Review and process medical claims (professional and/or institutional) according to US healthcare guidelines.
  • Validate claim information such as patient details, provider data, diagnosis codes (ICD), procedure codes (CPT), and modifiers.
  • Perform claim adjudication based on payer-specific policies (Medicare, Medicaid, commercial insurances).
  • Identify and correct claim errors, missing information, and coding discrepancies.
  • Route complex claims to the appropriate department for further review.

Claims Research & Resolution

  • Investigate claim denials, rejections, and pending claims.
  • Work with internal teams to obtain missing information or documentation.
  • Apply insurance rules and benefits to determine payment accuracy.
  • Follow up on unpaid or incorrectly paid claims.

Quality & Compliance

  • Maintain high accuracy standards and meet daily claim processing targets.
  • Ensure compliance with HIPAA guidelines and data security protocols.
  • Document actions taken in the system and maintain clear audit trails.

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Firstsource

Business Process Outsourcing (BPO)

Mumbai

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