Claim Processing Executive

Hexaware Technologies; Thane, Navi Mumbai, Mumbai; On-site; INR 350,000 - 550,000; Full time

Job summary

Hexaware Technologies in India is seeking a dedicated claims adjudication specialist to review incoming healthcare claims for accuracy and completeness, and to determine eligibility for payment.

You will analyze claims against payer policies, communicate with providers and policyholders, and use processing systems to enter and retrieve data. The role emphasizes timeliness, quality, and collaboration to improve adjudication processes while staying current with regulations.

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.