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Associate Medical Reviewer at Principal Human Capital Limited

Pune, maharashtra, India -

Full Time

Start Date

Immediate

Expiry Date

09 Sep, 26

Salary

0.0

Posted On

11 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Dental Claims Processing, Medical Claims Processing, Policy Analysis, Regulatory Compliance, Benefit Level Identification, Coordination Of Benefits, Ms Office, Written Communication, Verbal Communication

Industry

Financial Services

Description

Responsibilities Review, analyze, make appropriate and accurate decisions on dental claims in accordance with policy and state/federal law and regulations. Analyze claim detail and apply knowledge of claims procedures, product design, contract provisions and state and federal regulations to make appropriate, accurate, and timely claim decisions. This includes having a knowledge of plan provisions, determination of eligibility, verification of data input, identification of correct benefit level, coordination of benefits, and corrections. Qualifications • Graduate of life sciences (BDS, MDS, BAMS, BHMS, B Pharmacy, BSc Microbiology, BSc Biotechnology etc) by qualification. • Minimum of 2-4 years’ experience in medical/dental claims processing, and/or industry courses (i.e., LOMA). Prior claim paying, and/or medical/dental industry experience preferred. • Proficient in MS Office, written and verbal communication skills. Additional Information Willingness to work in US shift (5:30pm to 2:30am) during the 3-4 months of training period. Regular shift time – 1:30pm to 10:30pm in hybrid mode (3 days of working from office per week).

Responsibilities

Review and analyze dental claims to make accurate decisions based on policy, state, and federal regulations. This includes verifying eligibility, data input, and coordinating benefits to ensure timely claim processing.