BENGALURU · FULLTIME
Support Engineer
Infinite HR Solutions
Bengaluru · onsite · Posted 48d ago
Sourced from
Undisclosed2–5 yrsfulltimeBengaluru
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Section · 01
About this role
The Claims Processing Executive will be responsible for handling US health insurance Claims from healthcare providers or their authorized representatives. The executive will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines Key Responsibilities:
- Handles Claims related to providers/Members: Benefits, eligibility, claim status, claims adjudication, Claims Appeal and Grievances
- Claim research and Explanation of Benefits (EOB)
- Utilize internal systems and tools (via secure access methods) to retrieve and update information.
- Document all the daily tasks related to Claims adjudicated in the system.
- Escalate unresolved cases to the appropriate internal departments.
- Adhere to all privacy laws and regulatory compliance requirements related to CMS and HIPAA.
- Meet performance targets and service level agreements (SLAs). Required Qualifications:
- High school diploma or equivalent (mandatory)
- Some college education or a completed degree (preferred)
- Strong command of the English language (verbal and written)
- Basic knowledge of Windows OS and Microsoft Office tools Preferred Experience:
- 2-5 years of Claims Adjudication (preferably in healthcare or insurance)
- Experience working in office environment with US healthcare background
- Familiarity with claims processing systems and provider portals (preferred)
- Experience in Medicare plans, especially on I-SNP will be an added advantage.
- Experience in Medicare plans, especially on I-SNP will be an added advantage.
- Familiarity with claims processing systems and provider portals (preferred)
- Experience working in office environment with US healthcare background
- 2-5 years of Claims Adjudication (preferably in healthcare or insurance)
- Basic knowledge of Windows OS and Microsoft Office tools Preferred Experience:
- Strong command of the English language (verbal and written)
- Some college education or a completed degree (preferred)
- High school diploma or equivalent (mandatory)
- Meet performance targets and service level agreements (SLAs). Required Qualifications:
- Adhere to all privacy laws and regulatory compliance requirements related to CMS and HIPAA.
- Escalate unresolved cases to the appropriate internal departments.
- Document all the daily tasks related to Claims adjudicated in the system.
- Utilize internal systems and tools (via secure access methods) to retrieve and update information.
- Claim research and Explanation of Benefits (EOB)