- 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 (phone hidden)
Fresher only
Navi Mumbai location
Night shift
Role: Back Office Operations, Industry Type: BPM / BPO, Department: Customer Success, Service & Operations, Employment Type: Full Time, Permanent Role Category: Back Office Education UG: Any Graduate read more
Key Skills Skills highlighted with ‘‘ are preferred keyskills Non Voice Backend ProcessBackend