Knowledge Specialist

1 week ago

Pune, Maharashtra, India c3ef6728-8b26-4b96-9d07-b91b1fca7bdc Full time ₹ 40,00,000 - ₹ 1,20,00,000 per year

US Healthcare process

Shift - Includes Nightshift

Technical Skills:

  • Minimum 0 - 1 years experience in examining and processing Healthcare claims required.
  • Medical claims processing experience is a must.
  • Provider Maintenance, Enrollment experience required.
  • Proficiency with computers.

Process Skills:

Listed below are the primary job duties and responsibilities that are required:

  • Review claims for legitimacy and accuracy
  • Adjudicate claims by approving or denying them according to established guidelines.
  • Conducts investigation of pended claims and follow up with respective departments to finalize claims resolution.
  • Staying current with knowledge of products/ processes & services offered by the client,
  • Review and process medical claims according to guidelines within established turnaround time frames
  • Maintain accurate records/notes of claims related documentation.
  • Ensure full adherence to all the quality parameters.
  • Ensure 100 percent adherence to schedule.
  • Meeting all defined targets like Productivity, quality, Maintenance of required reports in Excel.

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