Medical Claims Review Associate Analyst

Overview

Medical Claims Review Associate Analyst/Clinical Case Manager role focused on case management to improve clinical outcomes for members.

What you'll do

• Assess treatment plans and goals and identify gaps in care, risks for readmission, or complications.
• Assess members’ health status and treatment plans to find gaps or barriers to healthcare.
• Establish a documented, patient-centric case management plan with appropriate parties.
• Interface with members, family/caregivers, and the healthcare team/provider, plus internal partners.
• Maintain accurate case management records, including cost/benefit analysis, savings, and data collection.
• Evaluate medical information against criteria, benefit plans, coverage policies, and determine medical necessity.
• Provide Information, Navigation and Coordination to customers outside the United States.

What you'll need

• Nurse Licensure is required.
• Fluent English reading, writing, and speaking is required.
• BSc & MSc Nursing is required.
• Demonstrated strong organizational and leadership skills are required.
• Strong interpersonal and communication skills are required.
• Demonstrates problem-solving and analytical skills are required.
• Proficiency with Microsoft Office products, call center software, and a variety of software is required.

Details

• Location: Bengaluru, India.
• Communication channels include videoconferencing and international phone calls.