Job Summary

We are seeking a skilled professional with 2 to 4 years of experience in Claims Adjudication and Claims domain expertise to join our team. The role involves working from the office during night shifts ensuring accurate and efficient claims processing while adhering to industry standards and organizational goals.

Responsibilities

Process claims accurately and efficiently ensuring compliance with organizational policies and industry standards.
Analyze claims data to identify discrepancies and resolve issues promptly to maintain operational efficiency.
Collaborate with internal teams to ensure seamless claims adjudication and timely resolution of queries.
Utilize technical expertise in claims adjudication to enhance the accuracy and reliability of claims processing.
Maintain detailed documentation of claims adjudication activities for audit and reporting purposes.
Provide insights and recommendations to improve claims processing workflows and reduce errors.
Ensure adherence to regulatory requirements and guidelines in all claims-related activities.
Communicate effectively with stakeholders to address concerns and provide updates on claims status.
Monitor claims processing metrics to identify areas for improvement and implement corrective actions.
Stay updated on industry trends and best practices to enhance claims adjudication processes.
Support training initiatives to enhance team capabilities in claims adjudication and domain-specific knowledge.
Utilize domain expertise in claims to contribute to strategic decision-making and process optimization.
Demonstrate proficiency in English for effective communication both written and spoken to ensure clarity in documentation and stakeholder interactions.

Qualifications

Possess strong technical expertise in claims adjudication with a proven track record of accurate claims processing.
Have domain knowledge in claims with a deep understanding of industry standards and practices.
Experience in payer domain is a nice-to-have skill that adds value to the role.
Exhibit excellent analytical skills to identify and resolve discrepancies in claims data.
Showcase effective communication skills in English to collaborate with teams and stakeholders seamlessly.
Demonstrate attention to detail and organizational skills to maintain precise documentation and reporting.
Display adaptability to work night shifts and contribute effectively in a dynamic work environment.
Bring a proactive approach to learning and staying updated on industry trends and regulatory changes.
Exhibit teamwork and collaboration skills to support organizational goals and enhance claims processing efficiency.

Certifications Required

Certified Professional Coder (CPC) or equivalent certification in claims adjudication.

SPE-Claims HC