**Position's General Duties and Tasks** **In these roles you will** **be responsible for:** + Review and process insurance claims. + Validate Member, Provider and other Claim’s information. + Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. + Coordination of Claim Benefits based on the Policy & Procedure. + Maintain productivity goals, quality standards and aging timeframes. + Scrutinizing Medical Claim Documents and settlements. + Organizing and completing tasks per assigned priorities. + Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team + Resolving complex situations following pre-established guidelines **Requirements for this role include:** + University degree or equivalent that required formal studies of the English language and basic Math + 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions + 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product. + 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. + 6+ months of experience that required prioritizing your workload to meet deadlines **Preferences:** - Optional (nice-to-have’s) + Ability to communicate (oral/written) effectively to exchange information with our client. + Commerce graduate with English as a compulsory subject Required schedule availability for this position is Monday-Friday (06:00pm to 04:00am IST). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement. **Roles and Responsibilities:** + Process Adjudication claims and resolve for payment and Denials + Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process + Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations + Ensuring accurate and timely completion of transactions to meet or exceed client SLAs + Organizing and completing tasks according to assigned priorities. + Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team + Resolving complex situations following pre-established guidelines **Requirements:** + 1-3 years of experience in processing claims adjudication and adjustment process + Experience of Facets is an added advantage. + Experience in professional (HCFA), institutional (UB) claims (optional) + Both under graduates and post graduates can apply + Good communication (Demonstrate strong reading comprehension and writing skills) + Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.