Health Claim Specialist - Internship Role

As a fresher gaining experience in Health Claims through training, your main responsibility will be accurately processing and adjudicating medical claims in compliance with company policies, industry regulations, and contractual agreements. - Review and analyze medical claims to ensure accuracy, completeness, and adherence to insurance policies and regulatory requirements - Verify patient eligibility, insurance coverage, and benefits for claim validity and appropriate reimbursement - Assign appropriate medical codes such as ICD-10 and CPT according to industry standards - Adjudicate claims based on criteria like medical necessity and coverage limitations for fair reimbursement - Process claims promptly and accurately using designated platforms - Investigate and resolve discrepancies, coding errors, and claims denials through effective communication - Collaborate with billing, audit, and other staff to address complex claims issues and ensure proper documentation To excel in this role, you should: - Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends - Provide courteous and professional customer service to policyholders, healthcare providers, and stakeholders - Document all claims processing activities, decisions, and communications accurately and comprehensively - Participate in training programs, team meetings, and quality improvement initiatives Qualifications required: - Masters/Bachelors degree in Nursing, B.Pharma, M.Pharma, BPT, MPT, or related field - Excellent analytical skills with attention to detail and accuracy in data entry - Effective communication and interpersonal skills for collaboration - Problem-solving mindset with commitment to continuous learning in healthcare claims processing,