Skill required: Claims Appeals - Claims Administration

Designation: Health Admin Services Associate

Qualifications:BCom/Bachelor of Arts/BMM

Years of Experience:1 to 3 years

Language - Ability:English(Domestic) - Intermediate

Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Songall powered by the worlds largest network of Advanced Technology and
What would you do The Appeals and Grievance (AG) Processor is responsible for reviewing, investigating, and resotving member and provider complaints, disputes. and appeals related to healthcare services and coverage decisions. The role ensures compliance with regulatory requirements. timely resolution. and accurate documentation while maintaining high quality and customer satisfaction. Review and process member and provider appeals and grievances in accordance with established guidelines. Investigate cases by gathering and analyzing relevant medical records, claims, and supporting documentation. Ensure all cases are handled within regulatory turnaround times (e.g .. CMS guidelines). Coordinate with internal departments (claims, enrollment billing) and external stakeholders (providers, members). Identify, document, and resolve discrepancies or issues impacting case outcomes. Maintain accurate and complete case documentation in internal systems.



Ensure compliance with HIPAA and confidentiality standards when hmdling sensitive information. Communicate decisions clearty to members and providers (written and/or verbal). Track and meet productivity, quality, and service-level targets.

What are we looking for Health Insurance Operations Healthcare Management Robust attention to detail and analytical skills knowledge of healthcare proces.ses, claims, and insurance policiE S Understanding of regulatory requirements (e.g .. CMS, HIPAA) Excellent written and verbal communication skills Problem-solving and decision-making ability Ability to work independently and manage multiple cases Time management and organizational ski Appeals and Grievance case processing experience

Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work . Please note that this role requires you to work in US shift time. No rotational or morning shifts

Qualification BCom,Bachelor of Arts,BMM

📌 Health Admin Services Associate (Maharashtra)
🏢 Accenture
📍 Maharashtra