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BPO HC & Insurance Operations Senior Associate at NTT DATA
Chennai, tamil nadu, India -
Full Time

Start Date

Immediate

Expiry Date

08 Apr, 26

Salary

0.0

Posted On

08 Jan, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Claims Adjudication, Healthcare Insurance, Analytic Skills, Communication Skills, Authorization Handling, COB, Duplicate Claims, Pricing Claims, Corrected Claims, In Network Providers, Out Of Network Providers, Deductible, Coinsurance, Co-Pay, Out Of Pocket, State Variations

Industry

IT Services and IT Consulting

Description
Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to 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 Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.
Responsibilities
The role involves processing adjudication claims and resolving payment and denials while ensuring timely completion of transactions. It also requires developing a solid understanding of healthcare insurance policies and resolving complex situations according to guidelines.