Remote Healthcare Claims Specialist (US Night Shift)

Urgent Opening : SEND YOU RESUME AT [email protected]

IMMEDIATE JOINERS ONLY
• Associate (US Health Care Claims) /Experienced Only
• WORK FROM HOME
• MUST HAVE WIFI (100 MBPS SPEED)

PACKAGE: UP TO 5LPA

Night Shift/US Shift
• 5 Days working - Sat and Sun fixed off
• Night Shift allowance
• Open Position : 20

SUMMARY A Healthcare Complex Claims Specialist is responsible for the thorough investigation, adjudication, and processing of complex healthcare claims in adherence to industry regulations and organizational policies. This role requires a deep understanding of analyzing medical records, healthcare coding systems (e.g., CPT, ICD-10, HCPCS) to accurately assess claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.
• Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claim processing.
• Excellent knowledge of Human Anatomy and medical terminology.
• Evaluate claims against established guidelines, contracts, and regulatory requirements.
• Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios.
• Analyze medical records, policy documents, and other relevant information to make informed claim decisions.
• Apply knowledge of healthcare benefits and payment policies.
• Provide clear and concise explanations of claim decisions to relevant parties.
• Identify trends and patterns in complex claims to contribute to process improvements.
• Candidate should be able to correctly calculate claim amounts for the customers.
• Complying with company regulations regarding HIPAA, confidentiality, and private health information.

QUALIFICATIONS:
• Should be Medical graduates (B-Pharma, M-Pharma, BSC or life science graduates).

MATHEMATICAL SKILLS:
• Should have basic math knowledge of calculating simple interest, compound interest.

REASONING ABILITY :
• Should have good English comprehension and analytical skills
• Should have excellent problem-solving skills with an eye for detail

WORK ENVIRONMENT :
• Should be open to work 24*7 and mandatory US timings,
• Night shift
• Ready to handle work pressure and ensure deliverables within timelines

Perks:
• Complete work from home
• Medical insurance
• Night Shift allowance