Job Description

Should possess U.S Health insurance claim processing experience Knowledge of medical billing and coding terminologies Ready to work in Night Shift as well as Day shift Understanding of plan documents and general benefits Familiarity with terms such as deductible, out of pocket, coinsurance, and copay Strong attention to detail and accuracy Ability to work in Microsoft word, Excel Process claims and ensure accuracy during testing of plan build Understand and analyze plan documents to determine benefits and coverage Ability to analyze, review and adjudicate provider claims Resolves medical claims by approving or denying documentation; calculates benefit amounts due; initiates payment and/or composes denial letter. Ensures the legal compliance of client policies, procedures, and guidelines, as well as legal compliance with state and federal regulations during the claim process. Review claims to determine if costs were reasonable and/ or medically necessary. Able to identify over-payments, underpayments and other irregularities in Processed claims. Verifying member eligibility, benefit coverage and researching or applying authorizations. Be able to integrate knowledge as a skilled specialist to solve problems and find new efficient workflows. Protects operations by keeping claims information confidential; must be HIPPAA compliant. Recognize areas of weakness, provide suggestions, and update documentation for process improvement. Perform general and administrative duties as assigned.
Job Type: Full-time

Pay: ₹20,000.00 - ₹40,000.00 per month

Experience:

US Health Insurance: 1 year (Required)
Location:

Navi Mumbai, Maharashtra (Required)
Shift availability:

Night Shift (Required) Day Shift (Required)
Work Location: In person