Medical Claim Adjudicator

2 days ago

kollam, India beBeeClaims Full time

Health Claims Specialist Job DescriptionWe are seeking a detail-oriented and experienced professional to fill the role of Health Claims Specialist. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with industry regulations, contractual agreements, and company policies.Reviewing and analyzing medical claims submitted by healthcare providers for accuracy, completeness, and compliance with insurance policies and regulatory requirements.Verifying patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.Assigning appropriate medical codes (e.g., ICD-10, CPT) to diagnoses, procedures, and services according to industry standards and guidelines.Adjudicating claims based on established criteria including medical necessity, coverage limitations, ensuring fair and accurate reimbursement.Responsibilities:The Health Claims Specialist will play a crucial role in ensuring timely processing of claims for healthcare services rendered, maintaining high standards of accuracy and efficiency in claims processing, and providing exceptional customer service to internal and external stakeholders.This position requires strong analytical skills, attention to detail, and effective communication skills to work collaboratively with healthcare providers, insurers, and internal teams.Benefits:This is an excellent opportunity for candidates who value accuracy, precision, and teamwork in a dynamic and fast-paced environment.Additional Information:Candidates should possess a solid understanding of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing.

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