Health Admin Services Associate - INC

Overview

Join Accenture's Healthcare Claims team to handle the administration of health claims, with a focus 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.
• Administer health, life, and property and casualty claims.

What you'll need

• Any graduation degree or equivalent experience.
• 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.
• This role may require working in rotational shifts.
• Routine problems are solved largely through precedent and referral to general guidelines; detailed to moderate instruction is provided on daily tasks.
• Interactions are within your own team and direct supervisor; you work as an individual contributor within a team with a focused scope of work.