Job Description

In this Role you will be Responsible For

• This is often a college graduate who has mastered the basic principles of the role and is able to handle more complex problems and projects.

• Most problems they handle require standard solutions.
• They may manage small projects with oversight from their supervisor.
• Supervised team typically responsible for transactions or processes.

• May assign work to direct reports. Prepares SOP for new process.
• Introduces best practice processes around work assignments, project management, and quality of output while maximizing overall team performance.
• Directs accurate and timely processing of transactions to meet or exceed client service level agreements.
• Identifies and resolves the more complex issues around nonstandard pending transactions.
• Review quality audits on accounts.
• May interact with clients and internal departments to resolve issues.
• Demonstrates professional courtesy and represents the company in a positive manner in all areas of internal and external communications.
• Ensures appropriate record keeping, reports, and related administrative functions are accurate and upto date
• Upon request, compiles and analyzes data to identify trends for root cause analysis.

Requirements for this role include:

• University degree or equivalent that required formal studies with good communication skills and basic Math
• 5+ years of Claims Adjudication experience that required you to review claims rules and workflows.
• 5+ years of experience in the US Healthcare market that required a working knowledge of HCPCS, ICD and CPT codes
• 5+ years of experience that required a 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
• Basic knowledge, understanding and application of project management principles and methodologies.

**Required schedule availability for this position is Monday-Friday 6PM/4AM IST. 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.