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Pa - Claims

3 weeks ago

Jaipur Rajasthan, India Genpact Full time

Genpact (NYSE: G) is a global professional services and solutions firm delivering outcomes that shape the future. Our 125,000+ people across 30+ countries are driven by our innate curiosity, entrepreneurial agility, and desire to create lasting value for clients. Powered by our purpose - the relentless pursuit of a world that works better for people - we serve and transform leading enterprises, including the Fortune Global 500, with our deep business and industry knowledge, digital operations services, and expertise in data, technology, and AI._

**_ _**
- To assess claims products to ensure that benefit spend is in accordance with the policies and rules relevant to our members’ policies and contracted agreements with providers of Healthcare._
- Responsibilities_
- _Data Entry of Information related to personal details, provider details, invoice information, procedure & impairment codes_
- _Validation of information entered by indexer and data Entry Operator_
- _Check & Select correct Pre-authorization_
- _Identify duplicate Claims and take appropriate action_
- _Reading & taking appropriate action on Alerts related to Members & providers._
- _Referring case to calling team for further information_
- _Dealing with Policy & Non Policy messages_
- _Interpreting, analyzing & further investigating the Policy messages on various tools like support point, info site etc._
- _Interpretation of hospital contracts & taking appropriate action basis that_
- _Referring cases to various department like HCS, TMT, Triage after adjudication as and when required_
- _Identify any over charge, ineligible chargers, contract compliance, Provider or Member Fraud_
- Qualifications we seek in you_
- Minimum qualifications_
- _Graduate_
- Preferred qualifications_
- _B.Sc. Life Science_
- _Good knowledge of healthcare & medical terminologies_
- _Eye for detail & investigative skills_
- _Good interpretation & comprehension skills_

**_
Job_**_Process Associate_

**_ Primary Location_**_India-Jaipur_

**_ Schedule_**_Full-time_

**_ Education Level_**_Bachelor's / Graduation / Equivalent_

**_ Job Posting_**_Jan 23, 2025, 1:40:32 AM_

**_ Unposting Date_**_Ongoing_
- Master Skills List_Operations_
- Job Category_Full Time_