Job Description

About the company

Connect and Heal is a Bengaluru-based health-tech company that provides end-to-end coordinated care for employees. Founded in November 2016, CNH aims to be the first Health Maintenance Organization in India.

We are one of the very few technology companies that own infrastructure and have meaningful influence over the delivery of care through partners. We employ over 700 doctors and paramedics who deliver outpatient care and emergency services across 60 cities in India. On top of this, we also have a managed network of hundreds of doctors who can consult across 35+ specialties and can converse in almost all Indian regional languages.Over the last 6 years, we have built a preferred network of 6000+ hospitals, specialist clinics, and 3500+ diagnostic centers across India. Our operations under the name MUrgency operates the largest on-demand Ambulance network in the country with over 4500 ambulances and counting.

At Connect and Heal, we are leveraging technology to create a holistic end-to-end healthcare management ecosystem for the people. During the COVID-19 pandemic, we discovered that teleconsultation is a powerful medium to get access to high-quality health outcomes for the majority of the cases of both acute and chronic diseases. Similarly, we believe that we can enable better access and higher accountability of care using technology in health care.

The problem we will solve together

The primary healthcare system in India is fragmented and ripe for disruption. Patients and caregivers need timely access, quality of service delivered, patient-centric experience, and assurance of the desired clinical outcomes.

By bringing together doctors, paramedics, providers, and emergency services, and working with corporates and the payors - we have an unprecedented opportunity to create a technology-led change in healthcare delivery. As the national health stack gets operational and adopted, we can bring accountability of care, the choice for the patients and caregivers, interoperability for seamless continued care, and transparency using technology as the backbone of this transformation.

We are building the most patient-centric healthcare company in the world. We need great people such as you to help us in achieving this dream

Job Title : Adjudicator

Location: Bangalore

Job Type: Full-time [Work From Office]

Years of experience: 1-10 years

Industry ref : healthcare & wellness, Medical, Insurance

Position Overview:

The Adjudicator is responsible for managing and analyzing reimbursement claims within an organization. They play a crucial role in ensuring accurate and timely processing of claims, identifying potential issues or discrepancies, and collaborating with various stakeholders to resolve them. The analyst must possess a strong attention to detail, excellent analytical skills, and a solid understanding of reimbursement policies and procedures.

Key Responsibilities:

Claim Processing: Review and process reimbursement claims submitted by clients, customers, or providers in accordance with established guidelines and policies.

Verification and Documentation: Verify the accuracy and completeness of claim documentation, including receipts, invoices, and medical records, ensuring compliance with relevant regulations and policies.

Data Analysis:

Analyze claim data to identify trends, patterns, and potential fraud or abuse. Utilize various tools and software applications to perform data analysis and generate reports.

Investigation and Research:

Conduct thorough investigations to resolve claim discrepancies, inconsistencies, or disputes. Collaborate with internal departments, external stakeholders, and insurance companies to gather additional information and documentation as required.

Policy Compliance:

Stay up-to-date with reimbursement policies, guidelines, and regulations to ensure accurate and compliant claim processing. Advise and educate internal teams and stakeholders on reimbursement-related matters.

Communication and Collaboration:

Communicate with clients, customers, providers, and insurance companies to resolve claim-related issues, provide clarifications, and facilitate timely reimbursements. Collaborate with cross-functional teams, such as finance, legal, and compliance, to address complex claim cases.

Quality Assurance:

Perform quality checks and audits on processed claims to identify errors, inconsistencies, or potential improvements in the reimbursement process. Propose and implement corrective actions as necessary.

Documentation and Reporting

: Maintain detailed and accurate records of claim activities, including correspondence, investigations, and resolutions. Prepare regular reports and summaries on claim metrics, trends, and outcomes for management review.

Process Improvement:

Identify opportunities for streamlining and improving claim processes to enhance efficiency, accuracy, and customer satisfaction. Participate in process improvement initiatives and provide recommendations based on data analysis and industry best practices.

Qualifications and Skills:

Bachelor's degree in healthcare administration, Pharma or life sciences. Relevant certifications or specialized training in reimbursement or claims management is a plus. Proven experience working in a similar role, preferably in a healthcare, insurance, or financial services setting. In-depth knowledge of reimbursement policies, procedures, and regulations, such as CMS guidelines and commercial insurance guidelines. Strong analytical and problem-solving skills, with the ability to analyze complex data sets and identify trends or anomalies.
Excellent attention to detail and accuracy, ensuring adherence to claim processing guidelines and standards.

Proficient in using computer applications and software, including claims management systems, databases, and data analysis tools. Effective communication skills, both written and verbal, to interact with internal teams, external stakeholders, and customers. Ability to work independently and as part of a team, managing multiple tasks and priorities within deadlines. Strong organizational and time management skills, with the ability to handle high volumes of claims efficiently.

Note:

The above job description is a general overview of typical responsibilities and qualifications for a Reimbursement Claim Analyst role. Actual job descriptions may vary depending on the organization, industry, and specific job requirements.

Job Type: Full-time

Pay: ₹400,000.00 - ₹450,000.00 per year

Benefits:

Leave encashment * Provident Fund