
Insurance Claims Operations Specialist
4 days ago
Process adjudication claims and resolve for payment and denials in a timely and accurate manner.
This role requires strong analytical skills, excellent communication skills, and the ability to work independently.
Key Responsibilities:
- Process adjudication claims and resolve for payment and denials
- Knowledge of healthcare insurance policy concepts, including in-network and out-of-network providers, deductibles, coinsurance, co-pay, and maximum inside limits and exclusions
- Ensure accurate and timely completion of transactions to meet or exceed client service level agreements (SLAs)
- Organize and complete tasks according to assigned priorities
- Develop and maintain a solid working knowledge of the healthcare insurance industry and all products, services, and processes performed by the team
Requirements:
- 1-3 years of experience in processing claims, adjudication, and adjustment process
- Experience with Facets is an added advantage
- Experience in professional, HCFA, institutional, UB claims optional
- Good communication and strong reading comprehension and writing skills
- Able to work independently with strong analytic skills
Work Schedule:
The required schedule availability for this position is Monday-Friday, 5:30 PM - 3:30 AM IST, AR Shift. The shift timings can be changed as per business requirements. Additionally, resources may have to do overtime and work on weekend basis as per business needs.
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