01Overview
Job Description (JD) Nursing Candidate (US Healthcare Claims Office) Job Title: US Healthcare Claims Associate / Medical Claims Analyst (Nursing Background)
Location: Office-Based / Work from Office (WFO)
Department: US Healthcare Operations / Revenue Cycle Management (RCM)
Employment Type: Full-Time
Job Summary We are looking for B.Sc. Nursing, GNM, or Post Basic B.Sc. Nursing graduates who are interested in building a career in the US healthcare industry. The role involves reviewing US medical claims, validating clinical documentation, coordinating with insurance guidelines, and ensuring accurate claim processing. No bedside patient care is involved.
Key Responsibilities Review medical records and insurance claims submitted by US healthcare providers. Verify diagnosis, procedures, and supporting clinical documentation. Identify missing or incomplete information required for claim adjudication. Analyze claim denials and recommend appropriate resolutions. Work with CPT, ICD-10-CM, HCPCS, and payer guidelines (training provided). Ensure compliance with HIPAA and US healthcare regulations. Maintain productivity and quality standards. Collaborate with internal quality and operations teams. Eligibility B.Sc. Nursing / GNM / Post Basic B.Sc. Nursing. Freshers and experienced nurses are welcome. Good understanding of medical terminology, anatomy, physiology, and pharmacology. Strong analytical and documentation skills. Basic computer knowledge. Good written and verbal English communication. .
