Backend Executive - International KPO - Noida

Job Summary:

We are seeking detail-oriented US Health Claim Associates to join our team. The role involves processing and reviewing healthcare claims, ensuring accuracy, and adhering to compliance guidelines. The ideal candidate should have a strong understanding of medical billing, claim adjudication, and US healthcare policies.

Key Responsibilities:

• Review and process healthcare claims for accuracy and compliance with US insurance policies.
• Verify patient details, insurance coverage, and claim eligibility.
• Analyze claim discrepancies, resolve billing issues, and handle claim rejections.
• Collaborate with insurance companies, healthcare providers, and internal teams for claim resolution.
• Maintain detailed and accurate documentation of claims processed.
• Ensure adherence to HIPAA regulations and company policies.
• Meet productivity and quality targets as per industry standards.

Requirements:

• Bachelors degree (preferably in healthcare, business, or a related field).
• Knowledge of CPT, ICD-10, HCPCS codes, and EOBs is preferred.
• Familiarity with US insurance policies, claim adjudication, and denial management.
• Strong analytical and problem-solving skills.
• Good communication skills, both verbal and written.
• Ability to work in a fast-paced environment with accuracy and attention to detail.

Preferred Skills:

• Experience with claim processing software or healthcare ERP systems.
• Knowledge of Medicaid, Medicare, and commercial insurance plans.
• Ability to handle multiple tasks and work effectively under deadlines.