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Carelon Global Solutions

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4.0

based on 2.9k Reviews

15 Carelon Global Solutions Jobs

HealthEdge Rules Payer(HRP) - Associate Claims

Legato Health technologies llp

4.0

based on 2.9k Reviews

1-4 years

₹ 2.3 - 4L/yr (AmbitionBox estimate)

Hyderabad / Secunderabad

1 vacancy

HealthEdge Rules Payer(HRP) - Associate Claims

Carelon Global Solutions

posted 19hr ago

Job Role Insights

Flexible timing

Key skills for the job

Operations MS Office Basic Medical Insurance US Healthcare Claims Adjudication

+ 4 more

Job Description

Position Title:

HealthEdge Rules Payer(HRP) - Associate Claims - GR - 39038-64673 - JR138805

Job Family:

CLM > Claims Support

Shift:

Job Description:

Job Title

Associate - Claims

Requirement Type

Full-Time Employee

Job Location

Hyderabad

Requirement Level

Associate Claims

Hiring Manager

Team Lead, Business Operations

Primary Skill

Claims - Medicare

Business

Business Operations - Commercialization

Skill Category

Claims

ABOUT ELEVANCE HEALTH

Elevance Health is a leading health company in America dedicated to improving lives and communities and making healthcare simpler. It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 45 million lives across 14 states.

A regular in Fortune 500 list, Elevance Health ranked 20 in 2022. Gail Boudreaux , President and CEO of Elevance Health has been a consistent name in the Fortune list of most powerful women and currently holds 4th rank on this list.

ABOUT CARELON

Carelon Global Solutions (CGS) is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health (Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.

Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, Limerick in Ireland and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective, and efficient.

OUR MISSION & VALUES

Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.
Our Values: Leadership | Community | Integrity | Agility | Diversity

JOB POSITION

Carelon Global Solutions India is seeking a highly creative and meticulous Associate - Claims, who will be responsible for all Processing level delivery & performance as per set SLA parameters. The incumbent will report to Team Lead - Business operations and must understand the business delivery, present and metrics with leadership; brief and deliver all in-house process delivery & requirements, apart from coordinating with onshore partners as and when required.

JOB RESPONSIBILITY

Associate - Claims (Business Operations) will be responsible for the following:

Responsible for processing / adjusting claims submitted by member / provider
Responsible for doing research and reaching out to different ancillary areas on time to find the resolution/answer related to the claim
Responsible for evaluating the discrepancies in the claim and correcting as per research and request received
Should be able to handle different states and complicated scenarios
Responsible for taking correct decision bases on different documents and information received
Work closely with SME/OE to highlights process gaps, share knowledge and help simplify process
Flexible to work in any shift & in office premises per set organizational/Business requirements

QUALIFICATION

Bachelors or Masters degree
Non-BTech (preferably)
Healthcare domain knowledge - Must

EXPERIENCE

Minimum 1 to 4 Years of Claims / Adjustment processing experience (US Healthcare)
Working Experience/knowledge on HealthEdge Rules Payer (HRP) platform in Claims- Must

SKILLS AND COMPETENCIES

Familiar with MS Office - basics (Excel/Power point/Outlook - primarily)
Very strong Communication & Comprehension skills with the ability to evaluate key technical/Calculations needed to deliver basic process delivery
Working knowledge on basic technologies around persistence, search, graph and distributed technologies
Excellent oral, written communication skills and problem-solving skills

THE CARELON PROMISE

Aligning with our brand belief of limitless minds are our biggest asset , we offer a world of limitless opportunities to our associates.

It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.

This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.

LIFE @ CARELON

Extensive focus on learning and development
An inspiring culture built on innovation, creativity, and freedom
Holistic well-being
Comprehensive range of rewards and recognitions
Competitive health and medical insurance coverage
Best-in-class amenities and workspaces
Policies designed with associates at the center

EQUAL OPPORTUNITY EMPLOYER

Reasonable Accommodation

Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.

If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.

Disclaimer: Offered designation titles differ*

Job Type:

Full time

Employment Type: Full Time, Permanent

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Carelon Global Solutions Interview Questions & Tips

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What people at Carelon Global Solutions are saying

3.9

Rating based on 425 Claims Associate reviews

Anonymous · Other in Hyderabad

Likes

Safety of employees is good

Dislikes

Removing the shift allowance, the some of cost cuttings and So much impacting the Score card, compare to legato and Carelon is legato Is best. So need to know the Employees problems and solve it if possible thank you.

Read 425 reviews