Medical Claim Professional

2 days ago

shimoga, India beBeeClaim Full time

Health Claims SpecialistWe are seeking an experienced professional to fill a Claims Processor position. The ideal candidate will have in-depth knowledge of medical claims and be skilled in accurate claim processing and adjudication.This role is crucial in ensuring timely and efficient claim processing while maintaining high standards of accuracy. The successful candidate will provide exceptional customer service and work collaboratively with internal teams to address complex claims issues.Key Responsibilities:Claim Review: Review and analyze medical claims for accuracy, completeness, and compliance with industry regulations and policies.Patient Eligibility: Verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.Coding and Adjudication: Assign medical codes (e.g., ICD-10, CPT) and adjudicate claims based on established criteria, including medical necessity and coverage limitations.Claim Processing: Process claims promptly and accurately using designated platforms.Discrepancies and Denials: Investigate and resolve discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internal teams.Collaboration: Collaborate with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication.Knowledge and Compliance: Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing.Customer Service: Provide courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding claim status, inquiries, and appeals.Documentation: Document all claims processing activities, decisions, and communications accurately and comprehensively in designated systems or databases.Training and Development: Participate in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall performance.

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    shimoga, India beBeeMedical Full time

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    shimoga, India beBeeClaims Full time

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    shimoga, India beBeeRegulatory Full time

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    shimoga, India beBeeCompliance Full time

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    shimoga, India beBeeCardiologist Full time

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    Shimoga, India Kottureshwara Hospital and Research Center Full time

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