Healthcare Claims Analyst

1 day ago

Chennai, Tamil Nadu, India beBeeHealthClaimsSpecialist Full time ₹ 9,00,000 - ₹ 12,00,000
Health Claims Specialist Job Description

We are seeking a detail-oriented and experienced professional to join our team as a Health Claims Specialist.

The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with industry regulation, contractual agreements, and company policies.

  • 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, procedure, and services according to industry standards and guidelines.
  • Adjudicate claims based on established criteria including medical necessity, coverage limitation, 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.
  • Provide courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding claim status, inquiries, and appeals.
  • Document all claims processing activities, decisions, and communications accurately and comprehensively in the designated systems or databases.
  • Participate in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall performance.

Requirements:

  • Education: Bachelor's degree in a related field (e.g B.A.M.S, B.U.M.S, B.H.M.S, M.B.B.S, B.D.S)
  • Experience: Minimum 1-2 years of experience in healthcare claims processing, medical billing, or health insurance administration
  • Skills: Proficiency in medical coding systems (e.g ICD-10, CPT) and claims processing software platforms; Strong understanding of healthcare insurance policies, cashless claims methodologies, and regulatory requirements
  • Personal Qualities: Excellent analytical skills with attention to detail and accuracy in data entry and claims adjudication; Effective communication and interpersonal skills with the ability to collaborate across multidisciplinary teams and interact professionally with external stakeholders

  • Hiring AR Analyst-Experienced @ Global Healthcare

    4 days ago

    Chennai, Tamil Nadu, India Global Healthcare Billing Partners Full time ₹ 5,00,000 - ₹ 8,00,000 per year

    Greetings from Global Healthcare Billing Partners Hiring AR Analyst-Experienced (US healthcare) @ Global Health care billing partnersExp Required: 6Months - 5Years of exp in AR AnalystJOB LOCATION: Velachery & Vepery-Chennai.Shift- Night shiftJob description:Should have 6 months-5 years Experience in AR Analyst.2.Good Knowledge of RCM and Denial...

  • Healthcare Claims Analyst

    7 days ago

    Chennai, Tamil Nadu, India beBeeAnalytical Full time ₹ 3,00,000 - ₹ 6,00,000

    Job Title: BPO HCWe are seeking a skilled professional to join our team in Chennai as a BPO HC and Insurance Operations Senior Representative. This role involves analyzing insurance claims, processing them according to standard operating procedures, and performing accurate calculations.This position requires strong analytical skills and attention to...

  • Healthcare Insights Analyst

    7 days ago

    Chennai, Tamil Nadu, India beBeeDataAnalyst Full time ₹ 1,50,00,000 - ₹ 2,00,00,000

    Job Title:Data Analyst - Healthcare InsightsWe are seeking a skilled Data Analyst to join our team and contribute to the development of predictive models and data-driven decision-making in the healthcare space.About the Role:Analyze large-scale claims and provider datasets to uncover insights and identify trends.Develop and optimize SQL queries, stored...

  • Healthcare Claims Specialist

    6 days ago

    Chennai, Tamil Nadu, India beBeeHealthcare Full time ₹ 48,00,000 - ₹ 72,00,000

    Job Title: Healthcare Claims Specialist  Contact insurance companies to follow up on outstanding claims. Analyze and resolve billing issues by understanding denials. Maintain accurate documentation of interactions and claim statuses.  Requirements Effective communication skills are essential Basic understanding of healthcare or willingness to learn is...

  • Healthcare Claims Expert

    2 weeks ago

    Chennai, Tamil Nadu, India beBeeMedical Full time ₹ 18,00,000 - ₹ 24,00,000

    Senior Medical Coding Auditor SIUDeveloping expertise in assessing trends and patterns in fraudulent healthcare claims requires deep knowledge of medical coding guidelines. The professional conducts thorough investigations into allegations of fraudulent and abusive practices.Key Responsibilities:Advances the organization's expertise in CPT HCPCS and ICD-10...

  • Healthcare Insurance Claims Specialist

    6 days ago

    Chennai, Tamil Nadu, India beBeeOperations Full time US$ 40,000 - US$ 80,000

    Healthcare Insurance Operations PositionJob Description:This role involves processing adjudication claims and resolving payment and denial issues in a timely and accurate manner. It requires knowledge of healthcare insurance policy concepts, including in-network and out-of-network providers, deductibles, coinsurance, copays, out-of-pocket maximums, and...

  • ESB Claim Analyst

    6 days ago

    Chennai, Tamil Nadu, India Ford Motor Company Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Job DescriptionThe Extended Service Business (ESB) Claim Analyst is responsible for evaluating claims related to Extended Service Business (Extended Warranty Contracts, Service Contracts etc) in accordance with the Terms and conditions of Contracts and as per Ford recommended repair / service procedures, thereby ensuring that quality repair / service has...

  • Healthcare Insurance Claims Specialist

    1 week ago

    Chennai, Tamil Nadu, India beBeeClaimsOperations Full time ₹ 6,00,000 - ₹ 10,00,000

    Job DescriptionAs a Claims Operations Associate, you will be responsible for processing claims adjudication and adjustment processes. You will have experience in professional HCFA and institutional UB claims, as well as knowledge of healthcare insurance policy concepts.Key Responsibilities:Audit claims as outlined by Policies and Procedures.Utilize...

  • Insurance Claims Analyst

    1 week ago

    Chennai, Tamil Nadu, India beBeeClaims Full time ₹ 60,00,000 - ₹ 90,00,000

    Job Title: Insurance Claims AnalystAs an Insurance Claims Analyst, you will play a vital role in ensuring timely and qualitative processing of insurance claims. Your responsibilities will include reviewing medical documents, policy documents, policy history, claims history, system notes, and applying trained client-level business rules to make appropriate...

  • US Healthcare Claims Specialist

    5 days ago

    Chennai, Tamil Nadu, India beBeeHealthcare Full time ₹ 9,00,000 - ₹ 12,00,000

    Job DescriptionWe are seeking a skilled professional to join our team as an AR Caller. The successful candidate will be responsible for contacting insurance companies, reviewing and analyzing denials, and addressing any discrepancies in the US Healthcare industry.This is a full-time on-site role that requires strong analytical skills, proficiency in...