Health Admin Services Associate - INC

Overview

Health Admin Services Associate on the Healthcare Claims team, administering health claims through core claim processing, with a focus on Medicare Part C and Part D appeals.

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.
• Support core claim processing such as registering claims, editing and verification, claims evaluation, and examination and litigation.
• Administer health, life, and property and casualty claims.

What you'll need

• Any graduation degree.
• 2 to 4 years of 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.
• Solves routine problems largely through precedent and referral to general guidelines.
• Interactions are within own team and direct supervisor.
• Receives detailed to moderate level of instruction on daily tasks and detailed instruction on new assignments.
• Works as an individual contributor within a team, with a predetermined, focused scope of work.