Hc & Insurance Operations Associate

9 hours ago

Coimbatore, India NTT DATA Full time

HC & Insurance Operations Roles and Responsibilities:

- 2-3 years of experience in processing claims adjudication and adjustment process
- Experience in professional (HCFA) and institutional (UB) claims
- Knowledge in handling authorization, COB, duplicate and pricing process
- Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
- Audit claims as outlined by Policies and Procedures. Utilize appropriate system-generated reports applicable for specialty claims.
- Document, track findings per organizational guidelines for reporting purpose.
- Based upon trends, determine ongoing Claims Examiner training needs and develop/implement training programs as approved by Senior Management.
- Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions to Senior Management.
- Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational requirements and applicable regulations.
- Assist in the development of Claims Department Policies and Procedures.
- Attend organizational meetings as required
- Adhere to organizational Policies and Procedures.

**Requirements**:

- 2-3 years of experience in processing claims adjudication and adjustment process
- Experience in professional (HCFA), institutional (UB) claims (optional)
- Both under graduates and post graduates can apply
- Good communication (Demonstrate strong reading comprehension and writing skills)
- Able to work independently, strong analytic skills Work Timings: Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement 2-3 years of relevant experience

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