01Key Responsibilities
- Review and process insurance claims and supporting documents.
- Verify member eligibility, policy coverage, and date-of-service details.
- Check claims for completeness and validate relevant medical information and codes.
- Apply policy terms, benefit rules, limits, sub-limits, tariffs, and applicable pricing guidelines.
- Determine claim outcomes, including approval, partial approval, or denial.
- Identify potential billing anomalies, overutilization, and fraud/waste/abuse indicators.
- Ensure claim accuracy, compliance, quality standards, and required TAT/SLAs.
- Support denial, appeals, grievance, and claim-related queries when required.
- Coordinate with internal teams, providers, and other stakeholders for claim resolution.
Required Skills:
- Good understanding of insurance claims and claim processing.
- Strong analytical and decision-making skills.
- Good attention to detail and documentation skills.
- Ability to work within defined TATs and quality standards.
- Good communication and coordination skills.
- Knowledge of ICD, CPT, and HCPCS codes is an advantage.
Compensation: 15,000.00 - 25,000.00 per month
Work Location: In person .
