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Role: Claim Adjudication Process Analyst
Experience: – 0-3 years
Notice Period: – Immediate joiners
Location– Gurgaon
Job Description:
Skills Expectation:
- Experienced level adjudicator providing analytical ability to review claim rules and workflows with Adjudication.
- Reviews claim requests to determine eligibility for processing and escalate to management as necessary.
- Responsible for the coordination and resolution of the administrative denials and appeals
- Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).
- Ability to resolve claims that require adjustments and adjustment projects , Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
- Organizing and completing tasks per 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
Requirements for this role include:
- University degree or equivalent that required formal studies of the English language and basic Math
- 1+ year(s) of experience processing claims for the US healthcare market
- Knowledge of HRP – added advantage.
- 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions – added advantage
- 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
- 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools
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