Health Claims Professional

1 week ago

mangalore, India beBeeClaim Full time

We are seeking a detail-oriented and experienced Health Claims Specialist to join our team.The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements.Key Responsibilities:Review and analyze medical claims submitted by healthcare providers for accuracy, completeness, and compliance with insurance policies and regulatory requirements.Verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.Assign appropriate medical codes (e.g., ICD-10, CPT) to diagnoses, procedures, and services according to industry standards and guidelines.Adjudicate claims based on established criteria, including medical necessity, coverage limitations, ensuring fair and accurate reimbursement.Process claims promptly and accurately using designated platforms.Investigate and resolve discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internal teams.Collaborate with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication.Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing.Our ideal candidate must possess the following skills and qualifications:Detail-oriented and organized individual with excellent analytical and problem-solving skills.Strong understanding of healthcare regulations, insurance policies, and industry standards.Ability to maintain confidentiality and handle sensitive information.Excellent communication and interpersonal skills.Strong technical skills, including proficiency in software applications used for claims processing and adjudication.We offer a competitive salary, comprehensive benefits package, and opportunities for professional growth and development.At our organization, we are committed to providing exceptional customer service and ensuring timely and accurate processing of medical claims. If you are a motivated and detail-oriented individual who is passionate about delivering high-quality results, we encourage you to apply for this exciting opportunity.

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