Job Description

Claims Processor


GENERAL OVERVIEW:
This section contains a synopsis of the main purpose(s) or functions(s) of the job, indicating what is done. This information will be used to develop the position posting.

Screens, reviews, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appropriately. Convert foreign currency to US dollar and code charges appropriately. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Takes the corrective action steps using enrollment, benefit and historical claim processing information.

ESSENTIAL RESPONSIBILITIES:
This section lists the major duties and responsibilities of the position. This is not an exhaustive list of all job duties/functions/attributes. Depending on Role, essential responsibilities may also include oversight and management of people and functions described below.

1. Determine if claim information is complete and correct. Enter/verify claims data.
2. Resolve claim edits (suspensions), review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination.
3. Meets all production and quality standards. Attends all required training classes.
4. Elevates issues to next level of supervision, as appropriate.
5. Maintains accurate records, including timekeeping records.
6. Other duties as assigned or requested.

QUALIFICATIONS:

Education, Experience, Licenses/Certifications Required

1. Bachelor’s Degree/Diploma in any stream
2. Freshers - Exposure to claims processing preferred
3. Typing speed of at least 50 words per minute
4. Basic computer knowledge (MS Office- excel, word, power point)

Knowledge, Skills and Abilities (This section describes additional preferred characteristics)
1. Ability to take direction and to navigate through multiple systems simultaneously.
2. Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
3. Ability to use mathematics to adjudicate claims.
4. Ability to solve problems within pre-defined methods and guidelines.
5. Knowledge of operating systems specific to claim processing.

WORK ENVIRONMENT
1. Work from office or home environment as situation demands.
2. Indian or US Holiday schedules as per client requirement.
3. Ready to work in shifts as required by the client.
4. Split week-offs, ready to work on Saturdays as situation demands.

Short Info

• 
  Posted: 0 day(s) ago
  Qualifications: Graduation
  Experience: 0 Years To 0 Years