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PA-Claims

4 months ago

Jaipur, 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.

We are inviting applications for the role of Claims Assessor
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