Claims Associate
- WAY For Services
- 0 - 3 years
- Noida, Gurugram
- 16 hours ago
- Email to a friend
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Job Description
Job Title: Claims Specialist
Department: Claims
Reports To: Team Leader (B2)
Key Skills Required Medical Claims Adjudication (Anatomy & Medical Report Interpretation)
Strong knowledge of Human Anatomy & Physiology to understand body systems, medical
conditions, and treatment procedures.
Ability to read and interpret medical records including physician notes, diagnostic reports, operative
summaries, and discharge summaries.
Understanding of medical terminology and clinical documentation used in healthcare settings.
Analytical skills to evaluate medical necessity, treatment appropriateness, and claim eligibility based
on clinical information.
Familiarity with healthcare coding systems such as ICD-10, CPT, and HCPCS (preferred but not
always mandatory for freshers).
Attention to detail and accuracy in reviewing medical data and making adjudication decisions.
Knowledge of healthcare insurance / US healthcare claims process (preferred for experienced
candidates).
Good comprehension and communication skills to document rationale and communicate claim
decisions clearly.
Ability to maintain productivity and quality standards in a high-volume claims processing
environment.
Basic computer proficiency and experience working with claims management or healthcare
systems.
SUMMARY
- Candidate should possess strong knowledge of human anatomy and medical terminology with the
ability to read, analyze, and interpret medical reports accurately to support precise and compliant
claims adjudication decisions..
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.
- Ability to review and analyze complex medical documentation with a high degree of accuracy to
prevent errors in claims processing.
- Evaluate claims against established guidelines, contracts, and regulatory requirements.
- Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios.
RESOURCE REQUEST FORM
- Analyze medical records, policy documents, and other relevant information to make informed claim
decisions.
- Demonstrate proficiency in healthcare coding systems (e.g., CPT, ICD-10, HCPCS, Revenue codes,
medical terminologies, Human Anatomy, Inpatient Vs. Outpatient claims) to accurately assess
claims.
- Apply knowledge of healthcare benefits and payment policies.
- Provide clear and concise explanations of claim decisions to relevant parties.
- Identify trends and patterns in complex claims to contribute to process improvements.
- Candidate should be able to correctly calculate claim amounts for the customers.
- Complying with company regulations regarding HIPAA, confidentiality, and private health
information.
QUALIFICATIONS
- Medical Graduates B-Pharma, M pharma, Biotech or life science graduates with 0- 2 years of
experience in handling US Health Insurance claims.
- Graduates having have a minimum of 3 years of experience in handling US HI claims.
LANGUAGE SKILLS
- Should have strong English comprehension, verbal and written skills
MATHEMATICAL SKILLS
- Should have basic math knowledge of calculating simple interest, compound interest.
REASONING ABILITY
- Should have good English comprehension and analytical skills
- Should have excellent problem-solving skills with an eye for detail
WORK ENVIRONMENT
- Should be open to work 24*7 and mandatory US timings, night shift
Ready to handle work pressure and ensure deliverables within timelines
How to Apply:-
Email us- la**************l@gm**l.com
Mobile Number- 9773528***
Job Classification
Industry: IT Services & ConsultingFunctional Area / Department: Customer Success, Service & OperationsRole Category: Customer Success, Service & Operations - OtherRole: Customer Success, Service & Operations - OtherEmployement Type: FreshersContact Details:
Company: WAY For ServicesLocation(s): Noida, Gurugram
Keyskills: human anatomy HCPCS ICD Phsyiology Medical Coding Health Care Services Anatomy Medical Terminology
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