We are looking for a Health Admin Services Associate to join the Healthcare Claims Administration team. The role involves handling end-to-end Medicare Appeals and Grievances, reviewing claim denials, validating documentation, coordinating with providers, and ensuring compliance with CMS regulations and turnaround time requirements.
Key Responsibilities
- Manage end-to-end healthcare appeal processing.
- Handle Medicare Part C and Part D Appeals and Grievances.
- Perform Appointment of Representative (AOR) validation.
- Conduct provider outreach for required information and documentation.
- Review claim denial rationale and supporting clinical documents.
- Prepare appeal cases for Medical Director review.
- Process appeal determinations and effectuation activities.
- Ensure compliance with CMS regulations and prescribed turnaround timelines.
- Maintain accuracy and quality while meeting process productivity targets.
Required Skills & Experience
- Any graduate with 1–3 years of relevant healthcare operations experience.
- Hands-on experience in Medicare Appeals and Grievances processing.
- Knowledge of Medicare Part C and Part D Appeals.
- Understanding of CMS regulations and turnaround time requirements.
- Experience in end-to-end appeal processing and AOR validation.
- Provider outreach and coordination experience.
- Ability to review denial rationale and clinical documentation.
- Valuable communication, analytical, and documentation skills.
Employment Details
- Permanent employment.
- Work from office in Mumbai.
- US rotational shift.
- Non-voice healthcare claims process.
- Candidates with a notice period of up to 45 days can apply.
📌 Health Admin Services Associate (Mumbai)
🏢 Gratitude India
📍 Mumbai
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