Responsibilities
- Responsibilities: Professionals in this group focus on processing insurance claims.
- They validate members, provider and other claims information.
- Professionals determine accurate payment criteria for clearing pending claims based on defined policy and procedure.
- They maintain productivity goals, quality standards and aging timeframes and scrutinize medical claim documents and settlements.
- They are involved in settlement of disputes and preparing case recovery through negotiations with the third party and providers.
- Professionals in this group work as fully contributed team member under broad supervision.
- They further build up on domain expertise along with technical skills.
- They work on complex projects which are not similar or routine based using standard concepts and principles using their knowledge and judgement.
- They require a qualified degree along with many years of work experience and are responsible for coaching/mentoring junior team members.
Qualifications
- Qualifications: Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience.
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