Claims Associate Ibas

SUMMARY

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.
- Ensure claims are adjudicated / adjusted as per the guidelines
- Responsible for timely request and follow-up of any/all required additional information for proper claim adjudication
- Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines
- Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files
- Work as a member of special or on-going projects that are important to area/process improvement
- Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers
- Should have 2 to 5 years on work experience in US Health care Insurance claims Domain
- Strong knowledge of claims, customer care processes and techniques
- Demonstrated ability to work well in a team environment
- Graduation from college or technical school or equivalent combination of education and experience; B.Sc preferred
- Excellent communication skills both verbal and written are required, should be able to communicate fluently with client.
- Typing speed of average 45 WPM
- High level of professionalism
- Must be available to work some holidays and weekends
- Strong problem-solving abilities
- Computer skills: They must be proficient with Microsoft Excel and Office

QUALIFICATIONS EDUCATION and/or EXPERIENCE
- Should have 2 to 5 years on work experience in US Health care Insurance claims Domain
- Strong knowledge of claims, customer care processes and techniques
- Demonstrated ability to work well in a team environment
- Graduation from college or technical school or equivalent combination of education and experience; B.Sc preferred
- Excellent communication skills both verbal and written are required, should be able to communicate fluently with client.
- Typing speed of average 45 WPM
- High level of professionalism
- Must be available to work some holidays and weekends
- Strong problem-solving abilities
- Computer skills: They must be proficient with Microsoft Excel and Office
- Analytical skills: They must possess analytical skills essentially for reviewing information, analyzing data, and making appropriate recommendations for improvement
- Communication skills: They must possess strong communication skills to ensure that employees are kept informed of developments effectively, and to ensure that all appropriate staff are aware of issues
- Organizational skills: Their job description requires them to establish an efficient workplace environment, therefore, it is important that they are able to manage a range of tasks and prioritize their responsibilities, and meet deadlines
- Self-starter/Teamwork abilities: Workforce analyst must be able to work independently as well as function effectively as a member of a team
- Ability to handle pressure: They require the ability to work effectively in a fast-pace situation and to handle stress, as well as to adapt to rapid changes in information, process, direction, or immediate workflow.
- Should have strong English comprehension, verbal and written skills
- Should have good English comprehension and analytical skills
- Should have excellent problem-solving skills with an eye for detail
- Should be open to work 24*7 and mandatory US timings, night shift Ready to handle work pressure and ensure deliverables within timelines

LANGUAGE SKILLS
- Should have strong English comprehension, verbal and written skills

REASONING ABILITY
- Should have good English comprehension and analytical skills
- Should have excellent problem-solving skills with an eye for detail

WORK ENVIRONMENT
- Should be open to work 24*7 and mandatory US timings, night shift
- Ready to handle work pressure and ensure deliverables within timelines