Claims Specialist

3 weeks ago


bangalore, India EXL Full time

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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