JOB Description : Claims Processor

Summary:

Process healthcare claims and determine the amount of healthcare benefits to be paid to the providers for the given portfolio.

Tasks:

- Process and adjudicate the claims as per the Table of Benefit of the member

- Check eligibility of the insured and dependents

- Check premium status where necessary

- Check claims as per policy requirements

- Check provider’s page for bank details and correct Provider -code to use

- Forward payment notices to Claims Supervisor for validation

- Check provider agreed tariffs in case of direct billing claims

- Capture the medical services with the adequate codes (ICD 10 – CPT)

- Process correct healthcare claims and prior approval agreements within deadlines and as per contract provisions

- Forward high cost amount claims to the medical team for evaluation

- Detect any case of abuse or fraud

- Claims audit targets are being met

- Ensure daily productivity targets are met as set by management

QUALIFICATIONS

Experience:

- Optional Experience: Previous experience in medical insurance

- Experience with ICD-10 and CPT medical coding
- English a must (German/french positive to have)

📌 Medical Claims Processor Specialist (India)
🏢 contactpoint 360
📍 India