Job Description

CLAIM EXAMINER ADJUDICATION We are looking for highly organized, diligent candidates with good interpersonal and communication skills. Claims examiners are required to review reports by claimants and claims adjusters, approve or reject a claim and assist claims adjusters in times of high case volume. Claims examiners are confident decision-makers playing an important oversight role in the claims process. The role comes with the responsibility of overseeing the work of their colleagues and ensuring that high standards are always met.

• Responsible for the coordination and resolution of the administrative denials and appeals.

• Ability to understand logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).

• Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.

• Meet & Exceed Production, Productivity, and Quality goals

• Process Insurance Claims timely and qualitatively

• Review medical documents, policy documents, policy history, Claims history, and system notes and apply the trained client-level business rules to make appropriate Claims decisions, call out claims trends, and flag fraud activities
• Determine whether payouts are reasonable.
• Approve, reject or refer a claim to a specialist.
• Meet with claimants and settle disputes.
• Ensure compliance with regulatory standards, company policy and guidelines.
• Provide assistance to claims adjusters to manage the volume of cases.
• Consult with specialists such as lawyers, engineers, architects and physicians.
• Assist attorneys and other specialists when defending the company against contestation.
• High school diploma for entry-level jobs.
• Bachelor\'s degree in finance or related field preferred.
• Sound administrative and organizational skills.
• Great attention to detail.
• Good interpersonal skills.
• Excellent verbal and written communication.
• Proficiency in mathematics and spreadsheet software.
• Demonstrated decision-making ability.

Synthesis Healthsoft Services & Solutions LLP Lan- +91-XXXXXXXXXX, +91 9789780526 Job Types: Full-time, Regular / Permanent Salary: 913,500.00 - 915,500.00 per month Benefits:

• Health insurance
• Paid sick time
• Paid time off
• Provident Fund

Schedule:

• Day shift
• Night shift

Supplemental pay types:

• Performance bonus
• Quarterly bonus
• Yearly bonus

Ability to commute/relocate:

• Chennai, Tamil Nadu: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor\'s (Preferred)

Shift availability:

• Night Shift (Preferred)
• Day Shift (Preferred)

Speak with the employer
+91-XXXXXXXXXX