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Claims Adjudication Process
Claims Adjudication Process
CIEL HR Services's logo

Claims Adjudication Process

Swati M's profile picture
Posted by Swati M
2 - 3 yrs
₹1L - ₹3L / yr
Coimbatore, Tamil Naidu
Skills
Claim Adjudication Process

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

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Shubham Vishwakarma

Full Stack Developer - Averlon
I had an amazing experience. It was a delight getting interviewed via Cutshort. The entire end to end process was amazing. I would like to mention Reshika, she was just amazing wrt guiding me through the process. Thank you team.
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About CIEL HR Services

Founded :
2015
Type :
Services
Size
Stage :
Profitable

About

CIEL HR is one of the best staffing agencies in the world with its base in India. It provides both flexible and permanent staffing services.
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