Resolve complex case escalations.
• •Support regulations, compliance, and policy interpretation.
• •Conduct quality reviews and calibration sessions.
• •Deliver process training and refreshers.
• •Drive process improvement initiatives.
• •Support IDR and Correspondence workflows.
• In this role you are required to do analysis and solving of lower-complexity problems.
• Your day to day interaction is with peers before updating supervisors.
• In this role you may have limited exposure with clients .
• You will be given moderate level instruction on daily work tasks and detailed instructions on current assignments.
• The decisions you make impact your own work and may impact the work of others.
• You will be an individual contributor as a part of a team, with a focused scope of work.
• Please note that this role may require you to work in rotational shifts
What would you do? • •Experience supporting audits and client reviews.
• •Process transition and training experience.
- You will be a part of the Healthcare Claims team which is responsible for the administration of health claims This team is involved in core claim processing such as registering claims editing verification claims evaluation and examination litigation
- Includes the administration of health, life, and property & causality claims.
• Includes activities involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.
What are we looking for? • Primary skill - Claims Administration - P1
• •Graduate degree.
• •4 to 6 years of Appeals and Grievance experience.
• •Subject Matter Expertise in Appeals (Commercial and or Medicare