Join a healthcare operations team supporting the administration and resolution of health insurance claims appeals. In this role, you will manage appeal cases, review supporting documentation, coordinate with providers, and ensure timely processing in line with applicable healthcare regulations.

Job Details

- Location: Mumbai

- Experience: 1–3 years

- Qualification: Any Graduation

- Employment Type: Permanent

- Work Mode: Work from Office

- Shift: US Shift

- Process: Non-Voice

- Notice Period: Up to 45 days

- Job Requisition ID: AIOC-S01672238

- Domain: Healthcare – Claims Administration

- Specialization: Claims Appeals and Grievances

Requirements

- Graduate in any discipline.

- 1–3 years of relevant healthcare operations experience.

- Hands-on experience in Medicare Appeals and Grievances.

- Knowledge of Medicare Part C and Part D appeals.

- Understanding of CMS regulations and turnaround time requirements.

- Experience in end-to-end appeals processing,



AOR validation, and provider outreach.

- Ability to assess denial rationale and review supporting clinical documentation.

Key Responsibilities

- Manage end-to-end claims appeal processing.

- Validate Appointment of Representative (AOR) documentation and conduct provider outreach.

- Review denial reasons and supporting clinical records.

- Prepare appeal cases for Medical Director review.

- Process appeal determinations and complete effectuation activities.

- Ensure compliance with CMS guidelines, regulatory requirements, and prescribed turnaround times.

Other Details

- Candidates should be comfortable working onsite in Mumbai and supporting US shift operations.

- Solid attention to detail, documentation accuracy, and the ability to meet processing deadlines are essential.

📌 Job vacancy: Health Admin Services Associate (Mumbai)
🏢 Gratitude
📍 Mumbai