Claims Associate/Sr. Claims Associate

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

Associate (US Health Care Claims)

WORK FROM HOME

Evening Shift : 5.30 PM to 2.30AM

5 Days working - Sat and Sun fixed off

Salary : Up to 4LPA CTC + 52,800 Allowance | 3LPA+ 52,800 Allowance for Freshers

Open Position : 40

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.
• 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.
• Demonstrate proficiency in healthcare coding systems (e.g., CPT, ICD-10, HCPCS, Revenue codes, medical terminologies, Human Anatomy, Inpatient Vs. Outpatient claims) to accurately assess claims.
• 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 (MBBS, B-Pharma, M-Pharma, BSC or life science graduates.
• Other graduates must have a minimum of 1 year or more of experience in handling US HI claims.
  

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 ENVIRONMEN:T

• 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