Job Description:

• Responsible for adjudication the US healthcare Claims.
• Reviewing claims processing policies and guidelines.
• Reviewing Physician/Hospital contract for correct payment method.
• Reviewing the proper precertification for the claims.
• Analyzing historical claims for member and provider for correct adjudication.
• Adhere to all client and company policies without exceptions.

Skills/Experience:

• Expertise in US Healthcare Claims Processing (Preferable).
• Good communication skill.
• Good basic mathematics, reasoning, and interpretation skills.
• Working knowledge of MS Office.

Candidate Profile:

Education/Qualification: Any Graduate (Except B.Tech, BCA or any technical qualification)

Work Experience: 1-3 years of experience in US health insurance claims processing and at least 1 years of experience in claims processing with Large Healthcare Payers Aetna.

Functional Skills: US Healthcare Claims Processing.

• Search Keywords: US health insurance, US healthcare, Claims processing.

Mandatory Skill:

• Minimum 2 Years of working experience in Claims and Claim Adjudication working for the client Aetna.
• ACAS
• Basic Overpayment experience.