Minimum 4.6 years of experience in claims adjudication, with at least 1 year in a SME on papers.
Key Responsibilities
Auditing Claims: Reviewing adjudicated claims to verify the accuracy of decisions, compliance with client guidelines, and adherence to healthcare/insurance standards.
Quality Monitoring: Tracking and analysing performance metrics, preparing reports, and sharing insights to improve the claims processing function.
Compliance: Ensuring all processes and handling of member/provider data comply with regulations such as HIPAA.
Collaboration: Working with operational teams to implement corrective measures and improve training programs.
Knowledge Management: Developing and maintaining a thorough understanding of insurance policies, products, and the broader healthcare insurance industry.
Key Skills & Qualifications
Technical Skills: Proficiency in claims adjudication systems, quality management tools (like the 7 QC tools), and methodologies like Six Sigma.
Analytical & Problem-Solving Skills: Ability to analyze complex data, identify discrepancies, and develop effective solutions.
Knowledge of Regulations: Strong understanding of industry regulations, insurance policies, and legal standards.
Communication Skills: Effective communication to share insights and collaborate with different teams and stakeholders.
Attention to Detail: Crucial for accurately verifying documentation and ensuring the completeness of claim information.
Interested candidates can call or whatsapp to
9087726632
for interview process!!!
Job Types: Full-time, Permanent
Pay: ₹450,000.00 - ₹600,000.00 per year
Benefits:
Health insurance
Leave encashment
Paid sick time
Paid time off
Provident Fund
Education: