- Overview of US Healthcare Industry
- A-Level professional with 1-2 years of experience in Actual Healthcare claims processing
- Processing and adjudication medical claims.
- Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.
- Accurately resolving pending claims using state and federal regulations and specific health plan criteria.
- Working within turnaround times to meet client performance guarantees for claims processing.
- Good logical thinking & analytical ability
- Should have exposure to MS Office (high proficiency with MS Excel)
- Good keyboard skills, minimum typing speed of 30 wpm or above
- Good verbal & written communication skills, ability to interact via email/online applications
ESSENTIAL SKILLS/PERSONALITY TRAITS:
- Eye for detail
- Logical thinking & analytical skills
- Ability to work with limited supervision
- Ability to work accurately and efficiently at all times, including redundant claim types
- Ability to multi-task and manage time efficiently under the pressure of deadlines
- Sensitivity to the confidential nature of the data and proprietary company information
- Ensure to meet all Statistical, Financial and TAT metrics while processing claims
- 100% adherence to transaction processing timelines
- Adhere to audit compliance (Internal, Statutory Audit) of all Healthcare processes as laid out by Company / the client of Company
- Ensure process guidelines are followed and met as documented
- Number of claims adjudicated/adjusted in a day
- Accurate and thorough review of all assigned claims
- Turnaround Time
- Attendance and Punctuality
- Team Player
- Personal grooming and etiquette