RCM Calling Executive

Nirvana Talent Solutions; Ahmedabad District; On-site; INR 300,000 - 600,000; Full time

Job summary

Nirvana Talent Solutions is seeking an experienced RCM Calling Executive in Ahmedabad, India. The role focuses on outbound calls to US insurers to verify claim status, follow up on Workers’ Compensation claims, and resubmit corrected claims as needed.

You will investigate rejections/denials, document call details, and coordinate with the billing team to resolve claim issues. Strong English communication and night-shift readiness are essential.

Qualifications

• Experience in healthcare RCM calling and follow-up required.
• Experience with Workers' Compensation claims required.
• Strong understanding of US healthcare billing and payer processes required.

Responsibilities

• Make outbound calls to US insurance companies to obtain claim status and payment information.
• Follow up on Workers' Compensation claims and understand the workers compensation billing process.
• Investigate rejected/denied/unpaid claims and identify reasons for rejection/denial.
• Communicate with insurance representatives and document call details and claim statuses.
• Analyze rejection/denial reasons and take corrective action.
• Resubmit corrected/rejected claims with required information/documentation.
• Follow up on resubmitted and pending claims until resolution.
• Review EOBs/ERAs and understand payment, adjustments, denials, and rejections.
• Maintain accurate records of claim follow-ups and communications.
• Coordinate with billing team to resolve claim-related issues.
• Meet daily productivity, quality, and follow-up targets.
• Ensure claims are handled within timely filing and resubmission deadlines.

Skills

RCM calling experience

Workers' Compensation claims

US healthcare billing

Phone communication with US insurers

Claim status / denials / appeals

Follow-up and issue resolution

Night shift readiness

Tools

MS Office

Job description

Job Summary : -

• We are looking for an experienced RCM Calling Executive with hands-on experience in US healthcare billing and Workers Compensation claims. The candidate will be responsible for contacting insurance companies to verify claim status, identify rejection or denial reasons, follow up on outstanding claims, and resubmit corrected claims as required.

Key Responsibilities : -

• Make outbound calls to US insurance companies to obtain claim status and payment information.
• Follow up on Workers Compensation claims and understand the workers compensation billing process.
• Investigate rejected, denied, and unpaid claims and identify the reason for rejection/denial.
• Communicate with insurance representatives and document call details, reference numbers, and claim status.
• Analyze claim rejection/denial reasons and take appropriate corrective action.
• Resubmit corrected/rejected claims with the required information or documentation.
• Follow up regularly on resubmitted and pending claims until resolution.
• Review EOBs/ERAs and understand insurance payment, adjustment, denial, and rejection information.
• Maintain accurate records of claim follow-ups and insurance communications.
• Coordinate with the billing team to resolve claim-related issues.
• Meet daily productivity, quality, and follow-up targets.
• Ensure claims are handled within required timely filing and resubmission deadlines.

Required Skills & Qualifications : -

• Prior RCM calling experience is mandatory.
• Workers Compensation claims experience is mandatory.
• Good understanding of US healthcare insurance and medical billing.
• Experience communicating with US insurance companies over the phone.
• Strong knowledge of claim status, rejections, denials, appeals, and resubmissions.
• Ability to understand and resolve claim issues independently.
• Good verbal and written English communication skills.
• Strong follow-up and problem-solving skills.
• Basic computer and MS Office skills.
• Ability to work in a US shift/night shift environment.

Preferred Experience : -

• Experience with Workers Compensation, No-Fault/Auto Accident claims, and commercial insurance claims.
• Experience working with medical billing/RCM software.
• Knowledge of CPT, ICD-10, claim forms, EOB/ERA, and insurance terminology.