Sureminds Solutions Pvt Ltd
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Position Insurance Follow Up - 2 (ISP-2)
Shift US Shift (05:30 PM to 03:00 AM)
Job function· Checking denials from EOBs, ERAs by calling the Insurance Companies. · Calling the insurance companies for the specification of denials. · Reprocessing the claim over the phone or reopening the claims on the online portals · Filing an appeal to the insurance companies with the required information · Checking status of the appeal filed and reprocessed claims through IVR, Calls and online payer’s portal · Refilling corrected claims with coding/demographic/authorization/referral corrections. · Disputing with the insurance companies on incorrect denials. · Working on FTH (Fix The Hole) to prevent future denials · Tasking to the clients and other teams for required information · Preparing Trending Analysis on the denials and escalating to Supervisors · Finding updates from payers via call or online for billing related information and sharing with the concern team/department to prevent denials. · Responsible for updating any internal databases, electronically storing and organizing patients' records, billing details, and registration forms.
Education +2 or Graduate in any stream
Training/Work
experience Billing & collections training and/or 1 year of industry experience in the relevant function
Other specifications Good English communication (reading, writing, listening, speaking) Understanding of US healthcare, HIPAA Good at Operating Computer - software and MS office
Capable of task execution based on work instructio
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A senior technical candidate who has managed AFS (Anti Fraud Solutions),Risk & Anti money laundering (AML) projects.
Experience: 15+ years of experience in BFSI domain.
Location: Mumbai
Note- Candidate should be from IT product companies only.
Key Skills: Hands on BFSI Domain experience, Strong leadership Qualities, Excellent communication and presentation skills
Roles & Responsibilities:
- Understand and maintain awareness of Global Regulatory guide lines, Risk management, and industry leading practices and use cases for AML, Anti-Fraud and Tax Reg.
- Responsible for AML and AFS product development & support and activities including roadmap planning and strategic direction.
- Enhancing our value proposition in the product demos and presentations to the clients.
- Proactively managing all aspects of the product life cycle including strategic planning, budget planning, product development, and marketing and communication strategy.
- Constantly enrich the software functionality and enhance its competitiveness working closely with Product Delivery Team.
- Should be able to speak in events on RegTech.
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We are Software Craftspeople. We are proud of the way we work and the code we write. We embrace and are evangelists of eXtreme Programming practices. We heavily believe in being a DevOps organization, where developers own the entire release cycle and thus own quality. And most importantly, we never stop learning!
We work with product organizations to help them scale or modernize their legacy technology solutions. We work with startups to help them operationalize their idea efficiently. We work with large established institutions to help them create internal applications to automate manual opperations and achieve scale.
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