Senior Quality Auditor - Claims Adjudication

Job description

Senior Quality Auditor - Claims Adjudication

Location : Navalur,Chennai

Roles & Responsibilities:

• In-depth Knowledge and Experience in the US Health Care Payer System.
• 4-10 years of excellent knowledge on client specifics and experience in all types of Claims Adjudication.
• Good experience in Quality team handling.
• Perform quality review of claims based on the documentation provided by client to ensure claim output meets all customer specifications
• Collects all findings during the audits and perform effective root cause analysis along with examiners & ops supervisors
• Generate multiple level of analysis from the audit findings and identify opportunities to improve overall process
• Circulate quality dashboards at agreed periodic intervals to all relevant stake holders
• Conduct 1-0-1 coaching / feedback on specific error scenarios
• Provide suggestions to Trainer and Ops on the slow performers who needs additional coaching / re-training on specific areas
• Tracks all feedback from client and provide constructive information to agents during daily quality team huddle
• Participates in client knowledge calibration exercise
• Understanding Client P&Ps and auditing documents / claims based on instruction guidelines.
• Record audit findings and prepare audit reports and circulate quality dashboard
• Organize ILP review meeting and quality briefings to update associates on any quality issues
• Analyze internal/client feedback and respond with details
• Handling Feedback sessions efficiently.

Interested Candidates share your CV - deepalakshmi.rrr@firstsource.com / 8637451071