Cliams Adjudication

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, ICD-10, 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 pre-established 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 where you had to apply business rules to varying fact situations and make appropriate decisions – 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.
• Strong experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools