US Claim Resolution Specialist

1 day ago


Hyderabad Secunderabad Telangana, India beBeeClaimResolutionspecialist Full time ₹ 1,50,000 - ₹ 28,00,000
Job Summary

We are seeking a skilled professional to join our team in resolving unpaid and denied claims. The ideal candidate will have excellent communication skills, a strong understanding of the US healthcare RCM process, and proficiency in MS Excel and billing software.

Main Responsibilities
  • Review and analyze unpaid/denied claims and initiate appropriate follow-up action.
  • Make outbound calls to US insurance companies (payers) to resolve claims in a timely manner.
  • Understand and interpret Explanation of Benefits (EOBs) and Claim Adjustment Reason Codes (CARCs).
  • Work on claim re-submissions, appeals, and denial resolutions to ensure accurate payment.
  • Update the billing system with clear and accurate documentation of actions taken.
  • Meet daily, weekly, and monthly productivity targets related to call volume and aging resolution.
  • Maintain compliance with HIPAA regulations and company policies.
Required Qualifications
  • Bachelor's degree in any field, with a preference for Life Science or Healthcare background.
  • Freshers: Excellent communication skills and interest in US healthcare, while experienced professionals should have 1-3 years of experience in AR Calling / Medical Billing / Denial Management.
Key Skills
  • Excellent verbal communication in English.
  • Basic understanding of the US healthcare RCM process.
  • Knowledge of insurance types (Medicare, Medicaid, Commercial).
  • Familiarity with denial codes and resolution techniques.
  • Proficient in MS Excel and billing software (e.g., NextGen, Kareo, Athena, eClinicalWorks).


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