SPE-Claims HC

2 weeks ago

Bengaluru, Karnataka, India Cognizant Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Job Summary

Clinical claim Review

Responsibilities

  • Oversee the claims adjudication process to ensure accuracy and compliance with industry standards.
  • Provide expertise in claims and payer domains to enhance operational efficiency.
  • Analyze claims data to identify trends and areas for improvement.
  • Collaborate with team members to streamline claims processing workflows.
  • Ensure timely resolution of claims issues to maintain customer satisfaction.
  • Develop and implement strategies to optimize claims adjudication procedures.
  • Monitor performance metrics to ensure adherence to service level agreements.
  • Communicate effectively with stakeholders to address claims-related inquiries.
  • Utilize technical skills to troubleshoot and resolve claims processing challenges.
  • Maintain up-to-date knowledge of industry regulations and best practices.
  • Contribute to the development of training materials for claims processing staff.
  • Support continuous improvement initiatives to enhance claims operations.
  • Document and report on claims processing activities for management review.

Qualifications

  • Possess strong analytical skills to evaluate claims data and identify improvement opportunities.
  • Demonstrate proficiency in claims adjudication processes and techniques.
  • Exhibit excellent communication skills to interact with stakeholders effectively.
  • Show a keen understanding of payer domain requirements and regulations.
  • Have the ability to work independently in a remote work environment.
  • Display strong problem-solving skills to address claims processing challenges.
  • Maintain a detail-oriented approach to ensure accuracy in claims adjudication.

Certifications Required

BSC Nursing with minimum 2 + years of Clinical experience

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