Claims Examiner

Contenido de trabajo

ORG. NAMEDECTREE INFOTECH PVT LTD DEPTARTMENT:Operations

TITLEClaims Examiner STATUS:Full-time

REPORTS TO:Team Manager

JOB SUMMARY/ORGANIZATIONAL IMPACT:To work for US based client health insurance claims operations department. Determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining client parameters.

PLEASE NOTE -Work experience in TPA, Pharmacy and other sectors will be considered as fresher. Only experience in US healthcare will be preferred****.

RESPONSIBILITIES/ ESSENTIAL FUNCTIONS:

• 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.
• Report over-payments, underpayments and other irregularities to supervisor.
• Communicate with reinsurance brokers to obtain information necessary for processing 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.

REQUIRED QUALIFICATIONS: Abilities

• Typing: Minimum 30 WPM typing speed.
• Communication : Ability to speak clearly, This includes customer needs assessment, so others can understand you. Meeting quality standards for services, and evaluation of customer satisfaction.Problem Sensitivity. Ability to forecast process risk.
• Written Expression. The ability to designing forms, and other office procedures communicate information and ideas in writing and terminology. so others will understand. Skills
• Active Listening. Giving full attention during training & OJT phase, taking time to Possess deep domain knowledge in understand the points being made, asking Healthcare and Insurance domain questions as appropriate, and not interrupting at inappropriate times.
• Service Orientation. Actively looking for experience such as provider contract ways to help people development, healthcare claims analysis, medical billing/coding, patient accounting,
• Critical Thinking. Using logic and claims auditing, and/or revenue cycle reasoning to identify the strengths and improvement required. weaknesses of alternative solutions, conclusions or approaches to problems. Must have demonstrated experience and knowledge of healthcare claims processing

Preferred additional Knowledge:

• In depth knowledge of Standard claim forms - UB04, UB92, HCFA.
• Sound understanding in medical billing terminologies.

AUTHORITY

This position does not have the authority; neither express nor implied, to legally bind the Company to any contract without written, documented consent of an Officer of the Company.

SPECIAL JOB DIMENSIONS:

Processing US based client health insurance claims forms over client applications.

ADHERENCE:

Employee must adhere/comply with all company’s Policies.

PHYSICAL REQUIREMENTS AND WORK ENVIRONMENT

While performing the duties of this job, the employee is regularly required to sit for long periods of time and must have the dexterity of hands and fingers to operate a computer keyboard, mouse, and other office equipment. The employee must have visual acuity to read and draft reports, memos, letters, etc. Specific vision abilities required by this job include vision adequate for the incumbent to perform the responsibilities and functions of the job efficiently. Must be able to hear, speak and communicate clearly.

The employee will work in smoke-free office surrounding; noise level is quiet to moderate.

The qualifications, physical demands and work environment described herein are representative of those an employee will encounter and must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed in this document are the minimum levels of knowledge, skills and abilities.

Job Type: Full-time

Salary: ₹18,000.00 - ₹25,000.00 per month

Schedule:

• Day shift
• Monday to Friday
• Night shift

Supplemental pay types:

• Performance bonus
• Quarterly bonus

Ability to commute/relocate:

• Navi Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (Required)

Application Deadline: 31/10/2023
Expected Start Date: 01/11/2023