Claims Adjudication

2 weeks ago

Bengaluru, India CIEL HR Services Full time

Resources should be completely Vaccinated to attend this interview & should have Hi-Speed Internet / Broadband Connection


**Work Location**: Work from Office - Hyderabad

Below are the MUST have Mandatory skills in Adjudication as per Project Team & panels
- Authorization
- Timely Filing
- Duplicate
- Copayment
- COB
- Medicare
- Medicaid

Requirement
- 1-3 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

**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.

Position's Overview
- Process Adjudication claims and resolve for payment and Denials
- Knowledge in handling authorization, COB, duplicate, pricing and corrected claims 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
- Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
- Organizing and completing tasks according to assigned priorities.
- Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
- Resolving complex situations following pre-established guidelines

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