2 CHCS Services India Pvt. Ltd. Jobs

-Urgent Opening : SEND YOU RESUE AT aakash.kulshrestha@chcs-services.com

IMMEDIATE JOINERS ONLY | Freshers

Associate (US Health Care Claims) | Freshers

WORK FROM HOME

Night Shift/US Shift

5 Days working - Sat and Sun fixed off

Night Shift allowance

Open Position : 30

SUMMARY A Healthcare Complex Claims Specialist is responsible for the thorough investigation, adjudication, and processing of complex healthcare claims in adherence to industry regulations and organizational policies. This role requires a deep understanding of analyzing medical records, healthcare coding systems (e.g., CPT, ICD-10, HCPCS) to accurately assess claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

• Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claim processing.
• Excellent knowledge of Human Anatomy and medical terminology.
• Evaluate claims against established guidelines, contracts, and regulatory requirements.
• Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios.
• Analyze medical records, policy documents, and other relevant information to make informed claim decisions.
• Apply knowledge of healthcare benefits and payment policies.
• Provide clear and concise explanations of claim decisions to relevant parties.
• Identify trends and patterns in complex claims to contribute to process improvements.
• Candidate should be able to correctly calculate claim amounts for the customers.
• Complying with company regulations regarding HIPAA, confidentiality, and private health information.

• QUALIFICATIONS:
• Fresher should be Medical graduates (B-Pharma, M-Pharma, BSC or life science graduates).

MATHEMATICAL SKILLS:

• Should have basic math knowledge of calculating simple interest, compound interest.

REASONING ABILITY :

• Should have good English comprehension and analytical skills
• Should have excellent problem-solving skills with an eye for detail

WORK ENVIRONMENT :

• Should be open to work 24*7 and mandatory US timings,
• Night shift
• Ready to handle work pressure and ensure deliverables within timelines

Perks:

• Complete work from home
• Medical insurance
• Night Shift allowance