Claims Examiner I

7 months ago

Chennai Tamil Nadu, India Smart Data Solutions LLC Full time

**Healthcare (Medical) Claims Examiner**

Smart Data Solutions (SDS) is a technology leader in healthcare process automation and interoperability. We are seeking to add an experienced Claims Examiner to our rapidly growing organization

A career at SDS is both challenging and rewarding. With over 500 colleagues across the globe, we've created an open and honest culture where we value constant learning and new ideas - no matter what role you're in at SDS. We are passionate about our customers’ success and helping our colleagues grow and develop

**What will you be doing?**
- Identifying, researching, processing and resolving claims/system edit pends according to desk level procedures (DLP), business guidelines, and quality standards.
- Meeting established productivity and timeliness standards to achieve individual and departmental performance goals as defined.
- Exhibiting capability of investigative and analytical research, demonstrating critical thinking and deductive reasoning
- Consulting and coordinating with various teams/departments to obtain information to ensure proper and timely resolution of claims/system edit pends.
- Demonstrating a high level of flexibility and adaptability; remaining available to transition to different work groups based on business need.
- Employing strong organizational skills, making good use of work time, and demonstrating an ability to effectively use all available resources to meet established claims processing goals.
- Demonstrating and maintaining current working knowledge of the client’s systems, procedures, forms, and manuals as applicable.
- Utilizing your experience with multi-tasking and prioritizing.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Adhering to all corporate and client mandatory training, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.
- Performing all other duties as assigned.

**What are we looking for?**
- Minimum: High School Diploma or equivalent
- Proficiency with Ten Key and Typing skills.
- Ability to read and interpret Standard Operating Procedure documents and performance / production reporting.
- Intermediate level experience with MS Excel
- 3 years of experience reviewing and interpreting data on medical claim forms.
- Familiarity with medical claim forms CMS1500 and UB04
- Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers
- Ability to maintain confidentiality and privacy.
- Knowledge of coordination of benefit (COB) principles and terminology.
- 3 year(s) of experience in Health Care claim operations
- Organizational skills and experience prioritizing project work and tasks.
- Experience in the health care industry working with Health Plans or Third-Party Administrators.
- Knowledge and understanding of government products and programs. (i.e. Medicare, Medicaid, etc.)

**Why this is the company for you?**
- A company culture that is authentic and values teamwork, humility, and fairness We work hard for our customers and have fun along the way
- A professional development and growth-oriented workplace
- Generous benefits including, health, dental, vision and disability insurance
- 401(k) with a company match to provide a better future in your retirement years
- Work-life balance with competitive paid time off package; including vacation, holidays, and a floating day

**Who is Smart Data Solutions?**

For over 20 years, Smart Data Solutions has been partnering with leading payer organizations to provide automation and technology solutions enabling data standardization and workflow automation. The company brings a comprehensive set of turn-key services to handle all claims and claims-related information regardless of format (paper, fax, electronic), digitizing and normalizing for seamless use by payer clients. Solutions include intelligent data capture, conversion and digitization, mailroom management, comprehensive clearinghouse services and proprietary workflow offerings. SDS’ headquarters are just outside of St. Paul, MN and leverages dedicated onshore and offshore resources as part of its service delivery model. The company counts over 420 healthcare organizations as clients, including multiple Blue Cross Blue Shield state plans, large regional health plans and leading independent TPAs, handling over 500 million transactions of varying types annually with a 98%+ customer retention rate. SDS has also invested meaningfully in automation and machine learning capabilities across its tech-enabled processes to drive scalability and greater internal operating efficiency while also improving client results.

SDS recently partnered with a leading growth-oriented investment firm, Parthenon Capital, to further accelerate expansion and product innovation.

**Location**: Smart Data Solutions is headquar

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