Job Description

Job Summary

Join our team as a Claims Specialist where you will leverage your expertise in claims adjudication to ensure accurate and efficient processing of healthcare claims. With a focus on payer domain knowledge you will contribute to optimizing operations and enhancing customer satisfaction. This role offers a work-from-home model with day shifts providing flexibility and work-life balance.

Responsibilities

Analyze and process healthcare claims to ensure compliance with adjudication guidelines and policies. Collaborate with cross-functional teams to resolve complex claim issues and improve processing efficiency. Utilize your expertise in claims adjudication to identify discrepancies and implement corrective actions. Monitor claim processing metrics and provide insights for continuous improvement. Ensure timely and accurate adjudication of claims to meet service level agreements. Communicate effectively with stakeholders to provide updates on claim status and resolution. Develop and maintain documentation related to claims adjudication processes and procedures. Participate in training sessions to stay updated on industry trends and best practices. Support the implementation of new technologies to enhance claims processing capabilities. Provide feedback to management on potential improvements in claims adjudication workflows. Engage in regular audits to ensure compliance with regulatory requirements and standards. Contribute to the development of strategies to optimize payer operations and customer satisfaction. Assist in the creation of reports and presentations to communicate claims processing outcomes. Qualifications Demonstrate proficiency in claims adjudication processes and techniques. Possess strong analytical skills to identify and resolve claim discrepancies. Exhibit excellent communication skills for effective stakeholder engagement. Have a keen eye for detail to ensure accuracy in claims processing. Show adaptability to work in a dynamic and fast-paced environment. Display knowledge of payer domain to enhance operational efficiency. Be familiar with healthcare industry standards and regulations.

Certifications Required

Bsc Nursing with 2-3 years of Clinical experience