Role & responsibilities

- Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication.
- Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial.
- Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information.
- Utilize claims processing systems and software to enter, update, and retrieve claims information accurately.
- Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse.
- Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy.
- Collaborate with team members to improve claims adjudication processes and contribute to departmental goals.
- Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development.

Interested candidate can share resume at [email protected]

📌 Back Office Executive - Fresher (Thane)
🏢 Hexaware Technologies
📍 Thane