Roles and Responsibilities: 2-3 years of experience in processing claims adjudication and adjustment process Experience in professional (HCFA) and institutional (UB) claims Knowledge in handling authorization, COB, duplicate and pricing process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Audit claims as outlined by Policies and Procedures. Utilize appropriate system-generated reports applicable for specialty claims. Document, track findings per organizational guidelines for reporting purpose. Based upon trends, determine ongoing Claims Examiner training needs and develop/implement training programs as approved by Senior Management. Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions to Senior Management. Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational requirements and applicable regulations. Assist in the development of Claims Department Policies and Procedures. Attend organizational meetings as required Adhere to organizational Policies and Procedures. Requirements: 2-3 years of experience in processing claims adjudication and adjustment process Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills Work Timings: Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement
