Knowledge Specialist

US Healthcare process

Shift - Includes Nightshift

Technical Skills:

• Minimum 0 - 1 years experience in examining and processing Healthcare claims required.
• Medical claims processing experience is a must.
• Provider Maintenance, Enrollment experience required.
• Proficiency with computers.

Process Skills:

Listed below are the primary job duties and responsibilities that are required:

• Review claims for legitimacy and accuracy
• Adjudicate claims by approving or denying them according to established guidelines.
• Conducts investigation of pended claims and follow up with respective departments to finalize claims resolution.
• Staying current with knowledge of products/ processes & services offered by the client,
• Review and process medical claims according to guidelines within established turnaround time frames
• Maintain accurate records/notes of claims related documentation.
• Ensure full adherence to all the quality parameters.
• Ensure 100 percent adherence to schedule.
• Meeting all defined targets like Productivity, quality, Maintenance of required reports in Excel.