Claims Specialist

4 weeks ago

Kochi, India EXL Full time

Essential Functions Reviewing and adjudicating medical claims for payment, determining coverage and appropriate coding and verifying information for accuracy.Evaluate and process claims in accordance with company policies and procedures, as well as to productivity and quality standards.Interprets and processes routine and claims including CMS 1500 and UB04.Reviews and analyzes Physician/Hospital contract for correct payment method in-process claims in order to identify and resolve errors prior to final adjudication.Analyzing historical claims for patient and provider for correct adjudication.Possess good Knowledge of medical terminology, coding and claims processing.Consistently maintains production and quality standards based on quality control expectations.Adaptability in cross training and multiple tasking.Assists claimants, providers, and clients with problems or questions regarding their claims and/or policies.Analyzing patient information in order to ensure payment accuracy.Prepares and prints drafts for payment of claims, refund requests and verifies that payments have been made.Consistently maintains production and quality standards based on quality control expectations.Primary Internal InteractionsActively participate in the team meetings, discussions and provide inputsCalibrate, Cooperate and support the team in pursuit of achieving and exceeding team goalsPrimary External InteractionsEmail CommunicationVerbal communication during Trainings or ON Query CallsSkillsTechnical SkillsWorking knowledge of MS office (Word, Excel and Power point) and Internet / OutlookProcess Specific SkillsMinimum experience of 1 to 3 years in US Healthcare claims processing/adjudication or medical billing with good performance records.Soft skills (Desired)Good communication skills, both verbal and writtenAptitude and keen eye for details

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