Cliams Adjudication

1 week ago

Bengaluru, Karnataka, India CIEL HR Services Full time

Must Have - Cliams Adjudication

Exp - 1 + years 4 + years

Location - Chennai
**Notice - Immediate

Skills Expectation:

Experienced level adjudicator providing analytical ability to review claim rules and workflows.
Reviews claim requests to determine eligibility for processing and escalate to management as necessary.
Responsible for the coordination and resolution of the administrative denials and appeals
Ability to understand logic of standard medical coding (i.e. CPT, ICD10, HCPCS, etc.).
Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
Organizing and completing tasks per 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 for this role include:

University degree or equivalent that required formal studies of the English language and basic Math
Strong experience processing claims for the US healthcare market
Knowledge of HRP added advantage.
Strong experience of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.