Roles and Responsibilities:

Process Adjudication claims and resolve for payment and DenialsKnowledge in handling authorization, COB, duplicate, pricing and corrected claims processKnowledge 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 variationsEnsuring accurate and timely completion of transactions to meet or exceed client SLAsOrganizing 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 teamResolving complex situations following pre-established guidelines

Requirements:

1-3 years of experience in processing claims adjudication and adjustment processExperience of Facets is an added advantage.Experience in professional (HCFA), institutional (UB) claims (optional)Both under graduates and post graduates can applyGood 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.