Job Description: Claims Appeals Claims Administration

Job Title: Health Admin Services
Skill Required: Claims Appeals Claims Administration
Experience: 1 3 Years

Location: Mumbai

Job Summary

We are looking for an experienced professional with expertise in Healthcare Claims Appeals and Grievance Management. The ideal candidate should have strong knowledge of Commercial and/or Medicare appeals, claims administration, regulatory compliance, and complex case resolution.

Key Responsibilities

- Handle and resolve complex healthcare claims appeals and grievance cases.
- Manage escalated cases and ensure timely and accurate resolution.
- Interpret healthcare regulations, compliance requirements, and policy guidelines.
- Perform quality reviews and participate in calibration sessions.
- Support Independent Dispute Resolution (IDR) and correspondence workflows.
- Conduct process training, refresher sessions, and knowledge-sharing activities.
- Identify process gaps and drive continuous process improvement initiatives.
- Support internal audits and client reviews.
- Assist in process transitions, knowledge transfers, and training activities.
- Ensure adherence to established quality standards, turnaround times, and compliance guidelines.

Required Skills & Experience
- Any Graduate degree.
- 1 3 years of experience in Healthcare Claims Administration.
- Strong experience in Claims Appeals and Grievance Management.
- Subject Matter Expertise (SME) in Commercial and/or Medicare Appeals.
- Experience handling complex case escalations.
- Good understanding of healthcare claims processes and regulatory guidelines.
- Experience in quality audits, client reviews,



and calibration sessions.
- Prior experience in process training and transition activities.
- Strong analytical, communication, and problem-solving skills.

Additional Requirements
- Ability to work independently and handle complex cases.
- Valuable attention to detail and decision-making skills.
- Willingness to work in rotational shifts.

VDart: Digital Consulting & Staffing Solutions

VDart is a leading digital consulting and staffing company founded in 2007 and headquartered in Alpharetta, Georgia. VDart is one of the top staffing companies in USA & also provides technology solutions, supporting businesses in their digital transformation journey. Digital consulting services, Digital consulting agency

Core Services:

- Digital consulting and transformation solutions
- Comprehensive staffing services (contract, temporary, permanent placements)
- Talent management and workforce solutions
- Technology implementation services

Key Industries: VDart primarily serves industries such as automotive and mobility, banking and finance, healthcare and life sciences, and energy and utilities. VDart - Products, Competitors, Financials, Employees, Headquarters Locations

Notable Partnership: VDart Digital has been a consistently strong supplier for Toyota since 2017 Digital Transformation Consulting & Strategy Services | VDart Digital, demonstrating their capability in large-scale digital transformation projects.

With over 17 years of experience, VDart combines staffing expertise with technology solutions to help organizations modernize their operations and build skilled workforce capabilities across multiple sectors.

📌 US Healthcare Operation (India)
🏢 VDart Software Services
📍 India