claim adjudication

3 weeks ago

Navi Mumbai, India INTEGRUM OUTSOURCE SOLUTIONS PVT LTD Full time
  • Should possess U.S Health insurance claim processing experience
  • Knowledge of medical billing and coding terminologies
  • Ready to work in Night Shift as well as Day shift
  • Understanding of plan documents and general benefits
  • Familiarity with terms such as deductible, out of pocket, coinsurance, and copay
  • Strong attention to detail and accuracy
  • Ability to work in Microsoft word, Excel
  • Process claims and ensure accuracy during testing of plan build
  • Understand and analyze plan documents to determine benefits and coverage
  • Ability to analyze, review and adjudicate provider claims
  • Resolves medical claims by approving or denying documentation; calculates benefit amounts due; initiates payment and/or composes denial letter.
  • Ensures the legal compliance of client policies, procedures, and guidelines, as well as legal compliance with state and federal regulations during the claim process.
  • Review claims to determine if costs were reasonable and/ or medically necessary.
  • Able to identify over-payments, underpayments and other irregularities in Processed claims.
  • Verifying member eligibility, benefit coverage and researching or applying authorizations.
  • Be able to integrate knowledge as a skilled specialist to solve problems and find new efficient workflows.
  • Protects operations by keeping claims information confidential; must be HIPPAA compliant.
  • Recognize areas of weakness, provide suggestions, and update documentation for process improvement.
  • Perform general and administrative duties as assigned.

Job Type: Full-time

Pay: ₹18, ₹25,000.00 per month

Experience:

  • US Health Insurance: 1 year (Required)

Location:

  • Navi Mumbai, Maharashtra (Required)

Shift availability:

  • Night Shift (Required)
  • Day Shift (Required)

Work Location: In person

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