Service Delivery Executive- Health Admin service representative

0 years

1 - 2 Lacs

Posted:4 weeks ago| Platform: Naukri logo

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Work Mode

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Job Type

Full Time

Job Description

The Claims Processor will play a key role in supporting the healthcare claims function by ensuring accurate and efficient processing of claims from start to finish. The position requires strong knowledge of claims operations, including receiving, reviewing, editing, pricing, adjudicating, and processing payments. The ideal candidate must be detail-oriented, analytical, and capable of working with established processes, guidelines, and systems to ensure timely and accurate claim outcomes.

Key Responsibilities:

  1. Receive incoming healthcare claims and verify completeness of required information.
  2. Review and edit claim details to ensure accuracy and compliance with policies and payer guidelines.
  3. Perform claim pricing based on predefined rules, fee schedules, and benefit policies.
  4. Adjudicate claims by determining eligibility, coverage, and appropriate benefit application.
  5. Process approved claims for payment in accordance with timelines and quality standards.
  6. Identify discrepancies, errors, or missing information and take corrective actions or route claims for further review.
  7. Maintain thorough documentation of claim decisions and actions taken during processing.
  8. Ensure compliance with regulatory requirements, organizational standards, and confidentiality policies.
  9. Work collaboratively with internal teams to resolve issues, clarify claim details, and support process improvements.
  10. Meet productivity and accuracy targets while delivering a consistent, high-quality output.

WORK STYLE - WFO.

SHIFT - 4 PM to 2 PM.

Location- Navi Mumbai

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Teamlease Digital

Staffing and Recruiting

Hyderabad

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