Job Description

Location: Chennai -3 Positions & Bengaluru- 3 positions
Key Responsibilities
Demonstrate in-depth knowledge of the US Healthcare Payer System and claims payment integrity processes.
Review and analyze claims for accuracy and compliance with client guidelines.
Utilize MS Office tools for reporting and documentation.
Understand and implement client Policies & Procedures (P&Ps) based on instruction guidelines.
Develop a strong understanding of business challenges and provide actionable insights.
Analyze internal/client feedback emails and report findings to managers.
Conduct coaching and feedback sessions effectively.
Participate in periodic knowledge calibration with clients or quality teams.
Troubleshoot floor issues and clarify queries with clients when necessary.
Key Performance Indicators (KPIs)
Consistently meet Service Level Agreements (SLAs) without exceptions.
Identify and implement process improvements proactively.
Perform analytics on processes and present findings to management to improve quality scores.
Collaborate with all business functions to ensure smooth operations.
Required Qualifications
3-5 years of experience in Claims Payment Integrity within US Healthcare Payer systems.
Strong knowledge of MS Office tools (Excel, Word, PowerPoint).
Excellent analytical, communication, and problem-solving skills.
Ability to handle client interactions and manage feedback sessions efficiently.

Skills Required