Designation: Health Admin Services Associate / Analyst
Experience: 1 to 5 Years
Qualification: Any Graduation
Job Summary
We are looking for candidates with experience in US Healthcare Claims Appeals and Grievances, preferably across Medicare Part C & D and/or Commercial Appeals.
Key Responsibilities
- Handle end-to-end Claims Appeals and Grievances processing.
- Review claim denials and supporting clinical documentation.
- Perform AOR validation and provider outreach.
- Prepare cases for Medical Director review and process appeal determinations.
- Handle complex escalations, IDR, and correspondence workflows.
- Ensure compliance with CMS guidelines and turnaround time requirements.
- Support quality audits, process training, and continuous improvement activities.
Required Skills
- US Healthcare Claims Appeals and Grievances.
- Medicare and/or Commercial Appeals experience.
- Knowledge of claims administration and healthcare regulations.
- Positive analytical and communication skills.
Other Requirements: Any Graduate; willing to work in rotational shifts.