Claims Associate

This is a fully remote position, open to applicants in India.

📋 Description

• Capable of reviewing and analyzing intricate medical documentation with a high level of precision to avoid errors in claims processing.

• Assess claims against established guidelines, contracts, and regulatory standards.

• Perform thorough research on complex claims, pre-existing conditions, and other detailed scenarios.

• Evaluate medical records, policy documents, and other pertinent information to make well-informed claim decisions.

• Exhibit expertise in healthcare coding systems (e.g., CPT, ICD-10, HCPCS, Revenue codes, medical terminologies, Human Anatomy, Inpatient Vs. Outpatient claims) to accurately evaluate claims.

• Utilize knowledge of healthcare benefits and payment policies.

• Offer clear and concise explanations of claim decisions to relevant stakeholders.

• Recognize trends and patterns in complex claims to aid in process enhancements.

• The candidate should be able to accurately calculate claim amounts for customers.

• Adhere to company regulations concerning HIPAA, confidentiality, and private health information.

⛳️ Requirements

• Medical graduates – MBBS, Physiotherapists, B-Pharma, or life science graduates with a minimum of 1 year of experience in managing US health insurance claims.

• Open to graduates and freshers.

• Must possess strong English comprehension, as well as verbal and written communication skills.

• Strong knowledge of medical science to understand medical reports.

• Basic math skills for calculating simple interest and compound interest are necessary.

• Good English comprehension and analytical capabilities are essential.

• Excellent problem-solving skills with a keen attention to detail are required.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health insurance coverage.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on employee well-being.