Medical Claims

Job Description:

Key Responsibilities

• Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources
• Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
• Deep understanding of medical coding, billing, and medical terminologies
• Operates with urgency in a real time service environment
• Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
• Review and evaluate medical insurance claims and documents.
• Analyze clinical information and medical reports for claim validation.
• Ensure accurate processing of claims as per policy guidelines.
• Maintain proper documentation and records.
• Coordinate with internal teams for claim-related queries.
• Adhere to process guidelines, quality standards, and TAT.

Eligibility Criteria

Educational Qualification:

• Qualified BPT, BDS, BMLT, BAMS, BHMS, BUMS
• B. Pharma (minimum 6 months experience required)

Experience:

• Minimum 6 months of relevant claims experience preferred.
• Freshers considered with qualifications BPT, BDS, BMLT, BAMS, BHMS, BUMS would be considered. 

Skills Required      

• Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA) 
• Deep understanding of medical records and medical terminologies
• Ability to produce high quality in production environment.
• Basic knowledge of medical terminology and healthcare processes.
• Understanding of medical insurance and claims processing.
• Good analytical and decision-making skills.
• Good computer knowledge and documentation skills.
• Typing speed of 25 Words per Minute with 90% Accuracy 
• Proficiency in healthcare information systems
• Ability to navigate through multiple applications
• Ability to understand and question established process guidelines for possible process improvements
• Attention for detail, and Strong analytical skills for processing medical documentation
• Possess keen sense of acquiring knowledge
• Adaptable and flexible to work in night & rotational shifts

Interview Process

• Mode: Walk-in Interview
• Process: All interview rounds will be completed on the same day.

Additional Information

• Work Mode: Office-based
• Shift : US Rotational Shift (24*7)
• Transport/Cabs : Both side cabs provided by company (under hiring zone)
• Career Growth: Opportunities in healthcare and insurance domain