Responsibilities: Perform medical claim adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise.

- Performs medical claim re-work calculations.
- Follow through completion of medical claim overpayments, underpayments, and any other irregularities.
- Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks.
- Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
- Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures.
- Review and handle relevant correspondences assigned to the team that may result in adjustment to claims.
- May provide job shadowing to lesser experience staff.

Utilize all resource materials to manage job responsibilities.

- Qualifications: 2+ years medical claim processing experience.
- 2+ experience in a production setting.

📌 Executive (Noida)
🏢 EXL Service
📍 Noida