TClaims auditor

Roles and Responsibilities:

• Process Adjudication claims and resolve for payment and Denials
• Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
• Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
• Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
• Organizing and completing tasks according to assigned priorities.
• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
• Resolving complex situations following pre-established guidelines

Requirements:

• 1-3 years of experience in processing claims adjudication and adjustment process
• Experience of Facets is an added advantage.
• Experience in professional (HCFA), institutional (UB) claims (optional)
• Both under graduates and post graduates can apply
• Good communication (Demonstrate strong reading comprehension and writing skills)
• Able to work independently, strong analytic skills

**Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.