Job Description
Roles and Responsibilities:
Perform research on the areas where Auditors have questions.
Train the Auditors and monitor the Quality improvement..
Create documentation on the research. Update training material and track the process changes.
Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
Organizing and completing tasks according to assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Resolving complex situations following pre-established guidelines
Requirements:
5+ years of experience in processing claims adjudication and adjustment process
Experience in Medicare, Medicaid, Commercial Insurance. State Federal Rules.
Good Understanding of Claim life Cycle. Provider Contract, Pricing, Fee schedules.
Process Adjudication claims and resolve for payment and Denials
Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
Experience in professional (HCFA), institutional (UB) claims (optional)
Both under graduates and post graduates can apply
Good communication (Demonstrate strong reading comprehension and writing skills)
Able to work independently, strong analytic skills
..Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.
5.00-7.00 Years
Perform research on the areas where Auditors have questions.
Train the Auditors and monitor the Quality improvement..
Create documentation on the research. Update training material and track the process changes.
Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
Organizing and completing tasks according to assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Resolving complex situations following pre-established guidelines
Requirements:
5+ years of experience in processing claims adjudication and adjustment process
Experience in Medicare, Medicaid, Commercial Insurance. State Federal Rules.
Good Understanding of Claim life Cycle. Provider Contract, Pricing, Fee schedules.
Process Adjudication claims and resolve for payment and Denials
Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
Experience in professional (HCFA), institutional (UB) claims (optional)
Both under graduates and post graduates can apply
Good communication (Demonstrate strong reading comprehension and writing skills)
Able to work independently, strong analytic skills
..Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.
5.00-7.00 Years
💡 Quick Summary
Seeking a career-building opportunity? The BPO HC Insurance Operations Senior Analyst BPO HC position is now open for candidates interested in the BPO Jobs sector. This role in Chennai offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in BPO Jobs is a plus.