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HC & Insurance Operations Associate at NTT DATA
Coimbatore, tamil nadu, India -
Full Time

Start Date

Immediate

Expiry Date

03 Feb, 26

Salary

0.0

Posted On

05 Nov, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Claims Processing, Adjudication, Authorization Handling, COB, Duplicate Claims, Pricing Claims, Corrected Claims, Healthcare Insurance Knowledge, Client SLA Management, Task Organization, Communication Skills, Reading Comprehension, Writing Skills, Problem Resolution, Guideline Adherence, Professional Claims Experience, Institutional Claims Experience

Industry

IT Services and IT Consulting

Description
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 1-3 years of experience in processing claims adjudication and adjustment process 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) 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 associate will process adjudication claims, resolving issues related to payment and denials. They will ensure accurate and timely completion of transactions while adhering to client SLAs.