Transaction Quality Assurance Sr. Assoc.

2 weeks ago

chennai, India NTT DATA Services Full time

Roles and Responsibilities:

  • 2-3 years of experience in processing claims adjudication and adjustment process
  • Experience in professional (HCFA) and institutional (UB) claims
  • Knowledge in handling authorization, COB, duplicate and pricing 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
  • Audit claims as outlined by Policies and Procedures. Utilize appropriate system-generated reports applicable for specialty claims.
  • Document, track findings per organizational guidelines for reporting purpose.
  • Based upon trends, determine ongoing Claims Examiner training needs and develop/implement training programs as approved by Senior Management.
  • Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions to Senior Management.
  • Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational requirements and applicable regulations.
  • Assist in the development of Claims Department Policies and Procedures.
  • Attend organizational meetings as required
  • Adhere to organizational Policies and Procedures.

 

Requirements:

  • 2-3 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

Work Timings:
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

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