Business Development Executive

Role: Claims Adjudication Process

Experience: 2.5-4 Years

Job Location: Coimbatore, Tamil Naidu

Work Timing: US Shift(Night Shift)

Job Description:

Claims Experience is required:

• More than 3 years of experience in handling the Healthcare claims adjudication process.

• Experienced level adjudicator providing analytical ability to review claim rules and workflows.

• Reviews claim requests to determine eligibility for processing and escalate to management as necessary.

• Responsible for the coordination and resolution of the administrative denials and appeals

• Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).

• Ability to resolve claims that require adjustments and adjustment projects , Identify claim(s) with inaccurate data or claims that require review by appropriate team members.

• Organizing and completing tasks per assigned priorities.

• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

• Resolving complex situations following pre-established guidelines

• Understanding the business requirement and providing good scalable solution
• Integrating user-facing elements developed by a front-end developers with server side logic
• Building reusable code and libraries for future use
• Optimizing the application for maximum speed and scalability
• Understanding differences between multiple delivery platforms such as mobile vs desktop, and optimizing output to match the specific platform
• Creating database schemas that represent and support business processes
• Implementing automated testing platforms and unit tests

• Engineers from Tier 1 colleges, B.Tech/ B.E from only from Tier 1 colleges
• Extensive and expert programming experience in anyone programming language (Golang/ C/ Java).
• A solid foundation in computer science, with strong competencies in data structures, algorithms, software design and distributed system applications
• Experience with building and scaling apps with RDBMS as well as NoSQLs.
• Experience creating scalable Web APIs for mobile and browser consumption
• Have a penchant for solving complex and interesting problems
• Worked in start-up culture with high levels of ownership and commitment
• Excellent coding skills – should be able to convert design into code fluently
• Working knowledge of - ReactJS, React Native, Golang, MySQL, NoSQL and hosting environment is AWS

As a VP Finance, you will be responsible for preparing financial modeling, structures, financial information, information memorandum, etc as per the need of the management, investors, rating agency and bankers.