- Process and adjudicate US healthcare insurance claims as per payer guidelines and policies.
- Review Professional, Inpatient, Outpatient, Skilled Nursing, and Maternity claims.
- Verify member eligibility, benefits, coverage, and authorizations.
- Handle Medicare, Medicaid, and Coordination of Advantages (COB) claims.
- Perform claim validation, payment calculations, settlements, and denial reviews.
- Investigate and resolve claims-related discrepancies and exceptions.
- Conduct overpayment recovery and claims audit activities.
- Ensure compliance with healthcare regulations, client requirements, and quality standards.
- Collaborate with internal teams, providers, payers, and other stakeholders to resolve claim-related issues.
- Maintain productivity, accuracy, and SLA target
📌 Program Specialist (Karnataka)
🏢 Allegis Group
📍 Karnataka
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