
Insurance Claim Resolution Specialist
1 day ago
Job Title: Insurance Claim Resolution Specialist
Job Summary:We are seeking an experienced and detail-oriented Insurance Claim Resolution Specialist to join our team. In this role, you will be responsible for resolving unpaid/denied claims by communicating with US insurance companies, analyzing Explanation of Benefits (EOBs), and updating billing systems.
Main Responsibilities:- Analyze and resolve unpaid/denied claims by making outbound calls to US insurance companies.
- Review and interpret EOBs and Claim Adjustment Reason Codes (CARCs) to ensure accurate claim processing.
- Update the billing system with clear and accurate documentation of actions taken.
- Meet daily, weekly, and monthly productivity targets (e.g., call volume, aging resolution).
- Bachelor's degree in a related field (Life Science or Healthcare background preferred).
- Freshers require excellent communication skills and interest in US healthcare, while experienced candidates should have 1-3 years in AR Calling/Medical Billing/Denial Management.
- 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, and proficiency in MS Excel and billing software.
- Basic understanding of the US healthcare RCM process.
- Knowledge of insurance types (Medicare, Medicaid, Commercial).
- Familiarity with denial codes and resolution techniques.
This role offers opportunities for professional growth and development in a dynamic and supportive work environment.
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