Senior Executive

• Responsible to reprice the non-par claims as per the Fee schedule and payment methodology.
• Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language.
• Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information.
• Provide input for new process development and continuous improvement.
• Supplier will share daily production report with stateside manager for review and feedback.
• Maestro Health will provide all applications and accesses required for claim repricing.
• Access requests should be completed within first week of project start date in order to start production.
• Requirement gathering & training session will require active participation from Maestro Health manager.

Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier.

Skills Required:

• Graduate with good written and oral English language skills
• Expertise in using Claim processing and validation application and worked in past on same profile/portfolio.
• Basic level proficiency on Excel to query production data and prepare/generate reports.
• Analytical mindset with strong problem solving skills.
• US Healthcare insurance domain experience desirable
• Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes.