Process Associate - Claims
Headstrong
Jaipur
5d ago
source : Shine

PA- Claims Assessor

To assess claims products to ensure that benefit spend is in accordance with the policies and rules relevant to our members policies and contracted agreements with providers of Healthcare.

Responsibilities

Data Entry of Information related to personal details, provider details, invoice information, procedure & impairment codes

Validation of information entered by indexer

Check & Select correct Preauthorization

Identify duplicate Claims and take appropriate action

Reading & taking appropriate action on Alerts related to Members & providers.

Referring case to calling team for further information

Validating information entered by data Entry Operator

Dealing with Policy & Non Policy messages

Interpreting, analyzing & further investigating the Policy messages on various tools like support point, info site etc.

Interpretation of hospital contracts & taking appropriate action basis that

Referring cases to various department like HCS,TMT, Triage after adjudication as and when required

Identify any over charge, ineligible chargers, contract compliance, Provider or Member Fraud

Qualifications

Minimum qualifications

Graduate

Preferred qualifications

B.Sc. Life Science

Good knowledge of healthcare & medical terminologies

Eye for detail & investigative skills

Good interpretation & comprehension skills

Report this job
checkmark

Thank you for reporting this job!

Your feedback will help us improve the quality of our services.

Apply
My Email
By clicking on "Continue", I give neuvoo consent to process my data and to send me email alerts, as detailed in neuvoo's Privacy Policy . I may withdraw my consent or unsubscribe at any time.
Continue
Application form