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
About Accenture
Accenture is a global skilled services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
What would you do? The Appeals and Grievance (A&G;) 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 cle

📌 Health Admin Services Associate (Navi Mumbai)
🏢 Accenture
📍 Navi Mumbai