Back Office Executive - Fresher

Hexaware Technologies; Thane, Navi Mumbai, Mumbai; On-site; INR 250,000 - 420,000; Full time

Job summary

Hexaware Technologies in India seeks a healthcare claims examiner to review incoming claims for accuracy and completeness, ensuring information required for adjudication is present. You will analyze claims data against payer policies to determine eligibility for payment or denial, and communicate with providers, policyholders, and internal teams to resolve discrepancies.

You will use claims processing systems to enter, update, and retrieve information, identify trends that may indicate fraud,

Responsibilities

• Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication.
• Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial.
• Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information.
• Utilize claims processing systems and software to enter, update, and retrieve claims information accurately.
• Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse.
• Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy.
• Collaborate with team members to improve claims adjudication processes and contribute to departmental goals.
• Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development.

Job description

Role & responsibilities

• Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication.
• Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial.
• Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information.
• Utilize claims processing systems and software to enter, update, and retrieve claims information accurately.
• Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse.
• Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy.
• Collaborate with team members to improve claims adjudication processes and contribute to departmental goals.
• Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development.