Job Summary

We are looking for an experienced RCM Calling Executive with hands-on experience in US healthcare billing and Workers’ Compensation claims. The candidate will be responsible for contacting insurance companies to verify claim status, identify rejection or denial reasons, follow up on outstanding claims, and resubmit corrected claims as required.

Key Responsibilities

- Make outbound calls to US insurance companies to obtain claim status and payment information.
- Follow up on Workers’ Compensation claims and understand the workers’ compensation billing process.
- Investigate rejected, denied, and unpaid claims and identify the reason for rejection/denial.
- Communicate with insurance representatives and document call details, reference numbers, and claim status.
- Analyze claim rejection/denial reasons and take appropriate corrective action.
- Resubmit corrected/rejected claims with the required information or documentation.
- Follow up regularly on resubmitted and pending claims until resolution.
- Review EOBs/ERAs and understand insurance payment, adjustment, denial, and rejection information.
- Maintain accurate records of claim follow-ups and insurance communications.
- Coordinate with the billing team to resolve claim-related issues.
- Meet daily productivity, quality, and follow-up targets.
- Ensure claims are handled within required timely filing and resubmission deadlines.





Required Skills & Qualifications

- Prior RCM calling experience is mandatory.
- Workers’ Compensation claims experience is mandatory.
- Valuable understanding of US healthcare insurance and medical billing.
- Experience communicating with US insurance companies over the phone.
- Strong knowledge of claim status, rejections, denials, appeals, and resubmissions.
- Ability to understand and resolve claim issues independently.
- Good verbal and written English communication skills.
- Strong follow-up and problem-solving skills.
- Basic computer and MS Office skills.
- Ability to work in a US shift/night shift environment.

Preferred Experience

- Experience with Workers’ Compensation, No-Fault/Auto Accident claims, and commercial insurance claims.
- Experience working with medical billing/RCM software.
- Knowledge of CPT, ICD-10, claim forms, EOB/ERA, and insurance terminology.

Key Performance Indicators (KPIs)

- Number of claims followed up daily.
- Successful claim resolution rate.
- Claim resubmission accuracy.
- Denial/rejection resolution rate.
- Quality and accuracy of documentation.
- Timely follow-up on pending claims.
- Call quality and productivity.

Important: Candidates without prior RCM calling and Workers’ Compensation claim experience may not be considered

Pay: ₹20,000.00 - ₹35,000.00 per month

Work Location: In person

📌 RCM Calling Executive (Ahmedabad)
🏢 Nirvana Talent Solutions
📍 Ahmedabad