Regulated Claims Settlement Coordinator II

Skill Requirements: Clinical Documentation Medical Record review & Billing Denials, appeals & grievance HIPAA regulations in documentation Claims Settlement process Claim Price negotiation Out of network Participating providers Non-participating providers Explanation of Benefits PPO networks . Detailed JD: Investigate and settle provider and client billing inquiries, including renegotiating claims to secure savings and meet or exceed department KPI goals. Maintain comprehensive tracking and documentation of all necessary information related to the research and settlement of assigned work. Collaborate with internal teams, including Client Services, Network and Vendor Management, Out of Network Services, and Bill Review & Audit, to ensure timely resolution of issues. Recommends process improvement opportunities within team scope. Communicate directly with clients to provide status updates and resolve issue notifications, maintaining strong customer relations. Ensure adherence to HIPAA and company standards regarding privacy and confidentiality. Provide support for the Customer Care Team when required. Perform other related responsibilities as assigned. Professional Experience: 3-5 years of experience in medical claims settlement. Strong understanding of PPO networks and the ability to interpret Explanation of Benefits, Plan Documents, PPO, and Complementary Network discounts. Outstanding written and verbal communication skills. Proficiency in MS Outlook, MS Word, MS Excel, and Internet Explorer. Excellent prioritization and organizational skills. Exceptional customer service and telephone communication skills. Additional Details: Shift Timing: Night shift (5:30 PM to 2:30 AM IST) Work Environment: Clean room Work Mode: On-site, 5 days a week Open Positions: 20 Experience Required: 3 to 5 years of experience