Process Developer Claims

22 घंटे पहले
फ़ुल-टाइम
Process Developer - Claims

In this role, you will be responsible for Data Entry of Information related to personal details, provider details, invoice information, procedure & impairment codes

Responsibilities
• Validation of information entered by indexer
• Check & Select accurate Pre-authorization
• Identify duplicate Claims and take appropriate action
• Reading & taking appropriate action on Alerts related to Members & providers.
• Referring case to calling team for further information
• Looking after Policy & Non-Policy messages
• Interpreting, analyzing & further investigating the Policy messages on various tools like support point, info site etc.
• Referring cases to various department like HCS, TMT, Triage after adjudication as and when required
• Identify Front End Savings by investigating claims to Identify any over charge, ineligible chargers, contract compliance, Provider or Member Fraud

Qualifications we seek in you

Minimum qualifications
• Any Graduate except technical
• Freshers are eligible

Preferred qualifications
• Good knowledge of healthcare & medical terminologies
• Eye for detail & investigative skills
• Good interpretation & comprehension skills
• Proven experience