Urgent Job Opening For US Healthcare - Back Office

Hi All,

Greetings From Hexaware !

Kindly find the below JD

The Claims Adjudication Specialist will be responsible for reviewing and processing healthcare claims on the payer side. This role requires an understanding of healthcare claims processing, strong analytical skills, and effective communication abilities. The specialist will ensure accurate and timely adjudication of claims while maintaining compliance with industry regulations and company policies. This position is ideal for individuals looking to start or further their careers in healthcare claims management with opportunities to learn and grow in a dynamic environment.

• Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication.
• Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial.
• Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information.
• Utilize claims processing systems and software to enter, update, and retrieve claims information accurately.
• Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse.
• Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy.
• Collaborate with team members to improve claims adjudication processes and contribute to departmental goals.
• Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development.

Interested candidates kindly contact the below person

Soumya - [phone removed]

[email removed]