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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