Job Summary

This role involves providing specialized expertise in claims adjudication within the healthcare domain. The candidate will work from the office during night shifts ensuring accurate and efficient claims processing. The position requires a minimum of 2 years and a maximum of 4 years of relevant experience with a focus on delivering high-quality outcomes.

Responsibilities

Analyze and process healthcare claims with precision ensuring compliance with adjudication guidelines and policies.
Collaborate with internal teams to resolve discrepancies and ensure seamless claims adjudication workflows.
Monitor claims data for accuracy and identify patterns or anomalies that may require further investigation.
Utilize technical expertise in claims adjudication to optimize processing times and reduce errors.
Provide detailed documentation and reports on adjudicated claims for auditing and review purposes.
Ensure adherence to regulatory requirements and company standards in all claims processing activities.
Communicate effectively with stakeholders to address queries and provide clarifications regarding claims adjudication.
Stay updated on industry trends and changes in healthcare claims policies to maintain expertise in the domain.
Support the implementation of process improvements to enhance efficiency and accuracy in claims adjudication.
Participate in training sessions and knowledge-sharing initiatives to strengthen team capabilities.
Leverage domain skills in commercial claims payer systems and claims management to deliver impactful results.
Contribute to the companys mission by ensuring timely and accurate processing of claims positively impacting customer satisfaction.
Maintain confidentiality and integrity in handling sensitive healthcare claims data. Qualifications
Demonstrate proficiency in claims adjudication processes and possess hands-on experience in healthcare claims systems.
Exhibit strong analytical skills to identify and resolve issues in claims processing efficiently.
Showcase familiarity with commercial claims payer systems and claims management as a nice-to-have domain expertise.
Display excellent communication skills to interact effectively with stakeholders and team members.
Possess a detail-oriented mindset to ensure accuracy and compliance in all adjudication tasks.
Show adaptability to work in night shifts and deliver consistent performance in a dynamic environment.
Highlight a commitment to continuous learning and staying updated on industry standards and best practices.

Certifications Required

Certified Professional Coder (CPC) Certified Claims Specialist (CCS)

SME-Claims HC