Claims Associate IBAS

SUMMARY

Claims Adjudicator should be energetic and reliable professionals to join the team as Claims Examiner. The successful candidates will be responsible for reviewing documents to identify doc type and index them to respective business units.

Claims adjudicator would require reviewing claims documents (invoices) to processing claims as per process guidelines, which includes reviewing policy documents, checklist, applications for eligibility, plan of care, HIPAA requirements, follow up for any missing / pending information on file. Based on which should take decision approve or denied claim. Candidate should have the commitment to customer satisfaction and an ability to make quick and accurate decisions.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

• Ensure claims are adjudicated / adjusted as per the guidelines
• Responsible for timely request and follow-up of any/all required additional information for proper claim adjudication
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines
• Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files
• Work as a member of special or on-going projects that are important to area/process improvement
• Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers
• Should have 2 to 5 years on work experience in US Health care Insurance claims Domain
• Strong knowledge of claims, customer care processes and techniques
• Demonstrated ability to work well in a team environment
• Graduation from college or technical school or equivalent combination of education and experience; B.Sc preferred
• Excellent communication skills both verbal and written are required, should be able to communicate fluently with client.
• Typing speed of average 45 WPM
• High level of professionalism
• Must be available to work some holidays and weekends
• Strong problem-solving abilities
• Computer skills: They must be proficient with Microsoft Excel and Office

QUALIFICATIONS EDUCATION and/or EXPERIENCE

• Should have 2 to 5 years on work experience in US Health care Insurance claims Domain
• Strong knowledge of claims, customer care processes and techniques
• Demonstrated ability to work well in a team environment
• Graduation from college or technical school or equivalent combination of education and experience; B.Sc preferred
• Excellent communication skills both verbal and written are required, should be able to communicate fluently with client.
• Typing speed of average 45 WPM
• High level of professionalism
• Must be available to work some holidays and weekends
• Strong problem-solving abilities
• Computer skills: They must be proficient with Microsoft Excel and Office
• Analytical skills: They must possess analytical skills essentially for reviewing information, analyzing data, and making appropriate recommendations for improvement
• Communication skills: They must possess strong communication skills to ensure that employees are kept informed of developments effectively, and to ensure that all appropriate staff are aware of issues

• Organizational skills: Their job description requires them to establish an efficient workplace environment, therefore, it is important that they are able to manage a range of tasks and prioritize their responsibilities, and meet deadlines
• Self-starter/Teamwork abilities: Workforce analyst must be able to work independently as well as function effectively as a member of a team
• Ability to handle pressure: They require the ability to work effectively in a fast-pace situation and to handle stress, as well as to adapt to rapid changes in information, process, direction, or immediate workflow.
• Should have strong English comprehension, verbal and written skills
• Should have good English comprehension and analytical skills
• Should have excellent problem-solving skills with an eye for detail
• Should be open to work 24*7 and mandatory US timings, night shift Ready to handle work pressure and ensure deliverables within timelines

LANGUAGE SKILLS

• Should have strong English comprehension, verbal and written skills

REASONING ABILITY

• Should have good English comprehension and analytical skills
• Should have excellent problem-solving skills with an eye for detail

WORK ENVIRONMENT

• Should be open to work 24*7 and mandatory US timings, night shift
• Ready to handle work pressure and ensure deliverables within timelines