Claims Resolution Specialist

Overview Please Note English language proficiency is required for this role This is a full-time work from office role This requires a U S schedule - India Night shift Work Location This is a Work from Office position and location is Bangalore at Block 12B Pritech Park 3rd Floor SEZ Survey No 51-64 4 Bellandur Village Bldg 9A Rd Bengaluru -Karnataka 560103 Shift Night Contact Nirmala 911 301 5045 Build Your Future Come join our thriving team as a Claims Resolution Specialist We are seeking ambitious self-motivated and driven people just like you for a rewarding career in the RCM Healthcare arena Why should you consider TSI part of TSI family of companies Paid training Team-oriented work environment Growth opportunity Generous Incentive opportunity Comprehensive benefits package available including medical insurance paid time off and paid holidays Transport facility As per policy and shift - Transportation provided Working 5 days week TSI Healthcare specializes in revenue cycle management offering tailored solutions for healthcare providers to address third-party insurance claims denials manage underpayments and optimize reimbursement processes The Claim Resolution Specialist plays a versatile role in the claims workflow tasked with submitting appeals to overturn denials and trigger payments or determining whether further action such as additional appeals or account closure is required Specialists in this role may prioritize tasks based on claim complexity and workload ensuring optimal productivity while maintaining compliance and accuracy By efficiently processing high volumes of low-balance claims the specialist ensures compliance accuracy and revenue recovery that supports client success Responsibilities Appeal Submission and Resolution Prepare and submit well-documented and persuasive appeals for denied claims leveraging payer guidelines contracts fee schedules and medical records to resolve issues and trigger payments Escalation Management Address claims escalated by Claim Status Specialists resolving complex denial scenarios such as coding disputes medical necessity issues or payer policy conflicts Underpayment Resolution Investigate and address discrepancies between expected and actual payments taking corrective action to resolve underpayments Final Determination Evaluate claims to determine if they are resolved or require further action such as additional appeals escalation or account closure based on client requirements Account Closure Review and close accounts when collection efforts have been exhausted ensuring proper documentation and compliance with client guidelines Account Review Feedback Identify incorrectly resolved claims and return them to the appropriate team for review correction or training contributing to process improvements Collaboration Utilize documentation provided by Document Retrieval Specialists and Claim Status Specialists to perform resolution activities efficiently Qualifications High school diploma or equivalent required Minimum of three years of experience in healthcare claims management denial resolution or appeal writing Experience in high-volume low-balance claims processing preferred Familiarity with payer-specific policies reimbursement methodologies and contract terms Knowledge of coding principles e g CPT ICD-10 HCPCS and medical necessity documentation is a plus This job description is not an exclusive or exhaustive list of all job functions that a team member in this position may be asked to perform Duties and responsibilities can be changed expanded reduced or delegated by management to meet the business needs of the company We provide Equal Employment Opportunity for all individuals regardless of race color religion gender age national origin marital status sexual orientation status as a protected veteran genetic information status as a qualified individual with a disability and any other basis protected by federal state or local laws INDJOBS