Validate Member, Provider and other Claim\xe2\x80\x99s information.
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
Coordination of Claim Benefits based on the Policy & Procedure.
Maintain productivity goals, quality standards and aging timeframes.
Scrutinizing Medical Claim Documents and settlements.
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+ years of experience where you had to apply business rules to varying fact situations and make appropriate decisions
2+years of adjudication 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.
6+ months of experience that required prioritizing your workload to meet deadlines
Ability to communicate (oral/written) effectively to exchange information with our client.
Commerce graduate with English as a compulsory subject
Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend\xe2\x80\x99s basis business requirement