Process Analyst_PAR Claims

enGen Global; Hyderabad, Chennai; Ibrido; INR 201.000 - 357.000; Tempo pieno

Descrizione del lavoro

enGen Global Hyderabad seeks a Claims Processor to verify and enter claims, determine benefit eligibility, and resolve claim edits. You will review data, ensure accuracy, and process payments in line with client requirements.

Freshers are welcome. The role supports work-from-office or from home and requires a typing speed of 50 wpm, basic MS Office skills, and the ability to navigate multiple systems while maintaining records and meeting quality standards.

Competenze

• Bachelor's degree or diploma in any stream.
• Freshers welcome; exposure to claims processing preferred.
• Typing speed of at least 50 words per minute.
• Basic computer knowledge including MS Office (Excel, Word, PowerPoint).

Mansioni

• Determine if claim information is complete and correct.
• Enter/verify claims data.
• Resolve claim edits (suspensions) and review history for eligibility.
• Review payment levels to reach final payment determination.
• Meet all production and quality standards.
• Elevate issues to supervision when needed.
• Maintain accurate records, including timekeeping.
• Perform other duties as assigned.

Conoscenze

Typing 50 wpm

Attention to detail

Formazione

Bachelor's Degree/Diploma

Strumenti

MS Excel

MS Word

MS PowerPoint

Descrizione del lavoro

General Overview

Screens, reviews, evaluate claims based on set audit requirements and shares audit findings for further action, following organizational policies and procedures as part of retrospective quality control review under risk and goverce area. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Takes the corrective action steps using enrollment, benefit, and historical claim processing information. Translate foreign language claims into English using software and code appropriately.

Essential Responsibilities

• Determine if the claim information is complete and correct.
• Enter/verify claims data.
• Resolve claim edits (suspensions), review history records and determine benefit eligibility for service.
• Review payment levels to arrive at final payment determination.
• Meets all production and quality standards.
• Elevates issues to the next level of supervision, as appropriate.
• Maintains accurate records, including timekeeping records.
• Other duties as assigned or requested.

Qualifications

• Bachelors Degree/Diploma in any stream
• Freshers - Exposure to claims processing preferred.
• Typing speed of at least 50 words per minute
• Basic computer knowledge (MS Office- excel, word, PowerPoint)

Knowledge, Skills, and Abilities

• Ability to take direction and navigate through multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within pre-defined methods and guidelines.
• Knowledge of operating systems specific to claim processing.

Work Environment

• Work from the office or home environment as the situation demands.
• Indian or US Holiday schedules as per client requirements.
• Ready to work in shifts as required by the client.
• Split week-offs, ready to work on Saturdays as the situation demands.