Claim Adjudication
1 month ago
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.
- 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.
**Salary**: ₹18,000.00 - ₹25,000.00 per month
Schedule:
- Day shift
- Night shift
Supplemental pay types:
- Overtime pay
- Performance bonus
- Shift allowance
**Experience**:
- US Health Insurance: 1 year (required)
**Location**:
- Navi Mumbai, Maharashtra (required)
Shift availability:
- Night Shift (required)
- Day Shift (required)
Work Location: In person
Expected Start Date: 15/04/2024
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