Health Admin Services Analyst
Accenture · Mumbai · onsite · Posted 65d ago
Undisclosed3–5 yrsfulltimeSourced from
About a minute. You'll make an account on the way through.
About this role
About The Role
Skill required: Claims Appeals - Claims Administration
Designation: Health Admin Services Analyst
Qualifications:BBA/BCom/BMS
Years of Experience:3 to 5 years
Language - Ability:English(Domestic) - Intermediate
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What would you do
The SME – Appeals Grievance (AG) serves as a functional expert responsible for providing guidance on complex cases, ensuring regulatory compliance, and supporting process improvements. This role acts as a bridge between operations, quality, and leadership by offering expertise in appeals and grievance handling, resolving escalations, and enhancing team performance.Subject Matter Expertise:Act as the primary point of contact for complex and escalated appeals and grievance casesProvide guidance on case handling, policy interpretation, and decision-makingEnsure accurate application of guidelines and business rulesCase Review Resolution:Review and validate high-risk, sensitive, or complex casesEnsure proper documentation, investigation, and resolution of appeals and grievancesSupport root cause analysis for recurring issuesCompliance Quality Assurance:Ensure adherence to regulations from the Centers for Medicare Medicaid Services (CMS) and internal policiesMaintain compliance with Health Insurance Portability and Accountability Act (HIPAA) for data security and confidentialityConduct quality audits and provide detailed feedback to improve accuracyAssist in preparing for internal and external auditsTraining Knowledge Sharing:Train new hires and provide ongoing training to team membersDevelop and update standard operating procedures (SOPs) and training materialsShare updates on policy changes, regulatory updates, and process improvementsStakeholder Support:Collaborate with cross-functional teams (claims, enrollment, billing, providers)Act as escalation support for team leads and managersCommunicate effectively with internal and external stakeholders regarding case status and resolutionsProcess Improvement Reporting:Identify process gaps and recommend improvementsAnalyze trends in appeals and grievances to reduce errors and complaintsSupport reporting on quality metrics, compliance, and operational performance
What are we looking for
Strong expertise in appeals and grievance processesIn-depth knowledge of healthcare regulations and complianceExcellent analytical and problem-solving skillsStrong communication and training abilitiesAttention to detail and decision-making capabilityAbility to handle complex and sensitive cases
Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems Your day to day interaction is with peers within Accenture before updating supervisors In this role you may have limited exposure with clients and/or Accenture management You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments The decisions you make impact your own work and may impact the work of others You will be an individual contributor as a part of a team, with a focused scope of work Please note that this role require you to work in US Shift time. No morning or rotational shifts
QualificationBBA,BCom,BMS
Skill required: Claims Appeals - Claims Administration
Designation: Health Admin Services Analyst
Qualifications:BBA/BCom/BMS
Years of Experience:3 to 5 years
Language - Ability:English(Domestic) - Intermediate
What would you do
The SME – Appeals Grievance (AG) serves as a functional expert responsible for providing guidance on complex cases, ensuring regulatory compliance, and supporting process improvements. This role acts as a bridge between operations, quality, and leadership by offering expertise in appeals and grievance handling, resolving escalations, and enhancing team performance.Subject Matter Expertise:Act as the primary point of contact for complex and escalated appeals and grievance casesProvide guidance on case handling, policy interpretation, and decision-makingEnsure accurate application of guidelines and business rulesCase Review Resolution:Review and validate high-risk, sensitive, or complex casesEnsure proper documentation, investigation, and resolution of appeals and grievancesSupport root cause analysis for recurring issuesCompliance Quality Assurance:Ensure adherence to regulations from the Centers for Medicare Medicaid Services (CMS) and internal policiesMaintain compliance with Health Insurance Portability and Accountability Act (HIPAA) for data security and confidentialityConduct quality audits and provide detailed feedback to improve accuracyAssist in preparing for internal and external auditsTraining Knowledge Sharing:Train new hires and provide ongoing training to team membersDevelop and update standard operating procedures (SOPs) and training materialsShare updates on policy changes, regulatory updates, and process improvementsStakeholder Support:Collaborate with cross-functional teams (claims, enrollment, billing, providers)Act as escalation support for team leads and managersCommunicate effectively with internal and external stakeholders regarding case status and resolutionsProcess Improvement Reporting:Identify process gaps and recommend improvementsAnalyze trends in appeals and grievances to reduce errors and complaintsSupport reporting on quality metrics, compliance, and operational performance
What are we looking for
Strong expertise in appeals and grievance processesIn-depth knowledge of healthcare regulations and complianceExcellent analytical and problem-solving skillsStrong communication and training abilitiesAttention to detail and decision-making capabilityAbility to handle complex and sensitive cases
Roles and Responsibilities:
QualificationBBA,BCom,BMS
Sourced from naukri
Skills
CMSGrievance HandlingRoot Cause AnalysisProcess Improvementleadershipbusiness rulesHealthcarecloudQuality AssuranceRegulatory ComplianceData SecurityoperationsAdministrationcomplianceHealth insuranceInsurance
About Accenture
Accenture
IT Services & Consulting
350k+
employees
1989
37 years old
Dublin
Ireland
About
Accenture plc is an Irish-American, professional services company based in Dublin, specializing in information technology services and consulting.
Industries
IT Services & ConsultingAnalytics & KPOSoftware ProductManagement Consulting
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