Medical Claims Specialist
6 days ago
As a Claims Associate, you will play a vital role in ensuring that benefits are disbursed in accordance with policies and contracted agreements.
This is an exciting opportunity to join our team of professionals who shape the future by delivering outcomes. Our work involves assessing claims products to ensure they meet policy requirements.
About the Role- Data Entry: You will be responsible for entering information related to personal details, provider details, invoice information, procedure, impairment codes.
- Validation: Ensure accuracy by validating data entered by indexers and data entry operators, and select the correct pre-authorization.
- Duplicate Claim Identification: Identify duplicate claims and take appropriate action.
- Alert Management: Read and respond to alerts related to members and providers.
- Case Referral: Refer cases to the calling team for further information and deal with non-policy messages.
- Policy Interpretation: Interpret hospital contracts and take necessary actions based on them.
- Overcharge Detection: Identify overcharges, ineligible charges, contract compliance, and potential fraud.
- Graduate Degree or Higher
- B Sc or Life Science Preferred
- Good Knowledge of Healthcare Medical Terminology
- Eye for Detail and Investigative Skills
- Strong Interpretation and Comprehension Skills
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