PC01158-HC-Web TPA-Claims Examiner-GGN

PeopleStrong; Gurugram District; On-site; INR 300,000 - 500,000; Full time

Job summary

PeopleStrong is seeking a dedicated individual for claims adjudication in the healthcare sector in Gurugram District, Haryana. The successful candidate will manage the adjudication of healthcare claims while also training new hires.

The role demands a graduate/post-graduate with relevant experience in ITES and claims processing. Candidates with a background in medical billing or science will have an added advantage. The position requires working in shifts and a solid understanding of medical terminologies.

Qualifications

• 2-3 years of experience in ITES, with 1 year in claims adjudication
• Knowledge of contract benefits and claims processing procedures
• Willingness to work in shifts and flexibility as per business needs

Responsibilities

• Adjudicate Healthcare claims including Medical, Dental, and Hospital
• Conduct training for new hires in the process
• Participate in conference calls with clients
• Meet productivity, schedule adherence, and quality standards
• Analyze claims for complete information

Skills

Medical Terminologies

Typing Speed (30-40 WPM)

Claims Processing

Teamwork

Education

Graduate/Post Graduate in any stream

Tools

Basic Computer Knowledge

Job description

Key Working Relationships

Will closely work with the process supervisor, process trainer and client as there is an initial intense training on claims adjudication. The processing guidelines also change with policies, which has to be closely monitored.

Key Responsibilities

• Adjudication of Healthcare claims (Medical, Dental, Hospital etc.)
• Impart training to new hires in the process.
• Be a part of direct conference calls with client.
• Participation in organizational activities.
• Will primarily be responsible for US Healthcare claims adjudication (Medical, Dental, Hospital etc.).
• Conduct data entry and re-work by reviewing, researching, investigating, negotiating, processing and adjusting claims.
• Read, review, and analyze claims for complete information.
• Verify benefit eligibility/membership and coverage type.
• Determine appropriate co-pay, co-insurance and deductible information according to plan documents.
• Adjudicate claims appropriately after verifying the plan documents thoroughly.
• Authorize the appropriate payment or refer claims to investigators for further review.
• Inform process supervisor about any change in processing guidelines to maintain accuracy of the claims payment.
• Be a good team player with high energy; may be required to impart hands‑on training to new joinees in the process upon gaining maturity in claims adjudication.
• Have a good hold on Medical Terminologies post classroom training as claims for adjudication come with description in Medical terms.
• Consistently meet established productivity, schedule adherence, and quality standards.
• Will be required to have conference calls with the clients under supervision.
• Actively participate in organizational activities (ISO 27001:2013, DPA, HIPAA).

Qualifications & Experience

• The candidate should be a graduate/post graduate in any stream with a good academic background.
• Should have 2-3 years of experience in ITES with minimum of 1 year experience in claims adjudication within a healthcare setting.
• Knowledge of contract benefits and claims processing procedures.
• Basic knowledge of computer with a typing speed of 30-40 WPM in Alpha keys and 20-30 WPM in numeric keys.
• Willing to work in shifts and flexible as per the business requirements.

Desired Skills / Experience

• People with prior experience in medical billing or US healthcare industry would be preferred.
• People from Science stream/Medical Transcription background would have an added advantage.