PC01173-HC-Web TPA-Claims Examiner-GGN

PeopleStrong; Gurugram District; On-site; INR 300,000 - 420,000; Full time

Job summary

Silverskills Pvt Ltd in India is seeking an Associate for Healthcare Claims Adjudication (US claims). You will handle adjudication of medical, dental, and hospital claims and train new hires in the process.

You will participate in client calls and support process operations under the Team Leader. The role requires a graduate or postgraduate with 0–1 year of ITES/claims experience, basic computer skills, and willingness to work in shifts.

Qualifications

• Graduate or postgraduate in any stream with good academic background.
• 2-3 years ITES experience with minimum 1 year experience in claims adjudication within a healthcare setting.
• Knowledge of contract benefits and claims processing procedures.
• Basic knowledge of computer with typing speed 30-40 WPM (Alpha) and 20-30 WPM (numeric).
• Willing to work in shifts as per business requirements.

Responsibilities

• Adjudication of US healthcare claims (Medical, Dental, Hospital etc.).
• Imparting trainings to new hires in the process.
• Be a part of direct conference calls with client.
• Participation in organisational activities.
• Will primarily be responsible for US Healthcare claims adjudication.
• Conduct data entry and re-work by reviewing, researching, investigating, negotiating, processing and adjusting claims.
• Should read, review, and analyze claims for complete information.
• Should verify benefit eligibility/membership and coverage type.

Skills

Back Office

Graduate

BA

Education

Graduate / Postgraduate in any stream

Job description

End Date 08 Jul 2027

Required Experience 0 - 1 years

Basic Details

BAND 5

Grade 9

Designation Associate

Organizational Information

Corporate Entity Sharp Group

Entity Silverskills Pvt Ltd

Business Unit Healthcare Services

Function HC- Web -TPA - Adjudication

Country India

Region North

City Gurgaon M-

Working Location Gurgaon M-

Skills

Back Office

Graduate

BA

Job Description

Designation Examiner/Sr. Examiner

Department - Process Operations - (Adjudication )

Reports to (Designation of the RO) Team Leader

Direct Reports Not Applicable

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

Job Description ( describes primary functions of the job ) Job Summary

• Adjudication of Healthcare claims (Medical, Dental, Hospital etc.)


• Imparting trainings to new hires in the process


• Be a part of direct conference calls with client


• Participation in organisational activities

Specific Responsibilities

• 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


• Should read, review, and analyze claims for complete information


• Should verify benefit eligibility/membership and coverage type


• Determine appropriate co-pay, co-insurance and deductible information according to plan documents


• Adjudicate claims appropriately after verifing the plan documents thoroughly


• Authorize the appropriate payment or refer claims to investigators for further review


• Should inform process supervisor about any change in processing guidelines so as to maintain accurateness of the claims payment


• Should be a good team player with high on energy as s/he may be required to impart hands on training to the new joinees in the process upon gaining maturity in claims adjudication


• Should have a good hold on Medical Terminologies post class room training as claims for adjudication comes 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


• Should actively participate in organisational activities (viz. ISO 27001:2013, DPA, HIPAA)

Qualification & Experience Essential Skills/ Experience & Qualification :

• The candidate should be a graduate/post graduate in any stream with 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 (words per minute) in Alpha keys and 20-30 WPM in numeric keys


• Willing to work in shifts and should be flexible as per the business requirements

Desired Skills/Experience & Qualification:

• 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