Senior Analyst - Claims Specialist

Responsibilities

• Responsibilities: Professionals in this group focus on processing insurance claims.
• They validate members, provider and other claims information.
• Professionals determine accurate payment criteria for clearing pending claims based on defined policy and procedure.
• They maintain productivity goals, quality standards and aging timeframes and scrutinize medical claim documents and settlements.
• They are involved in settlement of disputes and preparing case recovery through negotiations with the third party and providers.
• Professionals in this group work as fully contributed team member under broad supervision.
• They further build up on domain expertise along with technical skills.
• They work on complex projects which are not similar or routine based using standard concepts and principles using their knowledge and judgement.
• They require a professional degree along with many years of work experience and are responsible for coaching/mentoring junior team members.

Qualifications

• Qualifications: Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience.

Disclaimer: This job description has been sourced from a public domain and may have been modified by Naukri.com to improve clarity for our users. We encourage job seekers to verify all details directly with the employer via their official channels before applying.