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Claims Specialist
7 days ago
Job Description:
- Responsible for adjudication the US healthcare Claims.
- Reviewing claims processing policies and guidelines.
- Reviewing Physician/Hospital contract for correct payment method.
- Reviewing the proper precertification for the claims.
- Analyzing historical claims for member and provider for correct adjudication.
- Adhere to all client and company policies without exceptions.
Skills/Experience:
- Expertise in US Healthcare Claims Processing (Preferable).
- Good communication skill.
- Good basic mathematics, reasoning, and interpretation skills.
- Working knowledge of MS Office.
Candidate Profile:
Education/Qualification: Any Graduate (Except B.Tech, BCA or any technical qualification)
Work Experience: 1-3 years of experience in US health insurance claims processing and at least 1 years of experience in claims processing with Large Healthcare Payers Aetna.
Functional Skills: US Healthcare Claims Processing.
- Search Keywords: US health insurance, US healthcare, Claims processing.
Mandatory Skill:
- Minimum 2 Years of working experience in Claims and Claim Adjudication working for the client Aetna.
- ACAS
- Basic Overpayment experience.
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