Responsibilities:

- 3 years expereince into Employee benefits claims Eligibility verification and completeness review.

- Confirm patient insurance coverage, deductibles, and eligibility against policy guidelines.

- Calculate the correct reimbursement amount to issue payments or formally deny/pend invalid claims.

- Perform benefit determination and pay/deny decisioning per plan rules.

- Communicate with healthcare providers, patients, and internal departments to resolve discrepancies.

- Follow federal/state regulations and guidelines to protect sensitive patient information (HIPAA).

- Mitigate organizational risk, maintaining compliance and reputation.

Qualifications:

- Minimum Required Degree: Bachelor

- Preferred Degree: Bachelor's degree in insurance or related field

- Certificate(s)/Special Training: Insurance industry certifications AIC, AINS, Cert CII or any other relevant Insurance certification





- Experience (Career Level Guide): Minimum 2-3 years of experience in US Healthcare employee benefit claims

- Proven track record of successful claim resolutions and customer satisfaction

- Solid knowledge of US Healthcare insurance regulations, policies, and procedures

- Knowledge, Claims Handling Ability: Adjuster Claims

- Attention to Detail

- Understanding of medical terminology and coding

- Policy Compliance understanding like HIPAA

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Senior Analyst - Claim Operations (Pune)
🏢 Artex Risk Solutions
📍 Pune