Health Admin Services Associate - INC

Overview

Health Admin Services Associate in the Healthcare Claims team, responsible for administering health claims, focused on Medicare Appeals and Grievances processing.

What you'll do

• Handle end-to-end appeal processing.
• Perform AOR validation and provider outreach.
• Review denial rationale and supporting clinical documentation.
• Prepare cases for Medical Director review.
• Process determinations and effectuation activities.
• Take part in core claim processing such as registering claims, editing and verification, claims evaluation, and examination and litigation.
• Solve routine problems, largely through precedent and referral to general guidelines.

What you'll need

• Any graduation or graduate degree.
• 2 to 4 years healthcare operations experience.
• Experience in Medicare Appeals and Grievances processing.
• Experience with Medicare Part C and Part D Appeals.
• Knowledge of CMS regulations and turnaround requirements.

Details

• Location: Navi Mumbai.
• May require working in rotational shifts.
• Works as an individual contributor within a team, with detailed to moderate level of instruction on daily tasks.