Health Admin Services Associate - INC

Overview

Health Admin Services Associate in the Healthcare Claims team, responsible for administering health claims, including Medicare Part C and Part D appeals 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.
• Solve routine problems, largely through precedent and referral to general guidelines.
• Register claims, edit and verify claims, evaluate and examine claims, and handle litigation as part of core claim processing.

What you'll need

• Any graduation.
• 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.
• Individual contributor role within a team, with a predetermined, focused scope of work.
• Detailed to moderate level of instruction on daily tasks.
• Interactions are within own team and direct supervisor.
• May require working in rotational shifts.