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Hc and Insurance Operations Associate
3 months ago
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, copay, 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 preestablished guidelines
Requirements:
- 13 years of experience in processing claims adjudication and adjustment process
- 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
