Role & responsibilities
Process and adjudicate US healthcare insurance claims as per payer guidelines and policies.
Review Qualified, Inpatient, Outpatient, Skilled Nursing, and Maternity claims.
Verify member eligibility, advantages, 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 (India)
🏢 Allegis Group
📍 India
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