US Healthcare Claims /Appeals -Associate/Analyst

Placewell; Navi Mumbai; Vor Ort; INR 350.000 - 650.000; Vollzeit

Zusammenfassung

Placewell in Navi Mumbai, India is seeking a Health Admin Services Associate to join the Healthcare Claims team. You will handle the end-to-end processing of health claims and Medicare appeals, collaborating with medical reviewers and providers to ensure accurate determinations.

The role requires 1 to 4 years of healthcare operations experience, with knowledge of Medicare Part C and Part D appeals. You will validate AORs, review denial rationales, and prepare cases for Medical Director review.

Qualifikationen

• Graduate degree.
• 2 to 4 years healthcare operations experience.
• Experience in Medicare Appeals and Grievances processing.
• Experience with Medicare Part C and Part D Appeals.

Aufgaben

• Handle end-to-end appeals processing, ensuring timely and accurate case resolution.
• Perform AOR (Appointment of Representative) validation and provider outreach.
• Review denial rationales and supporting clinical documentation.
• Prepare and organize appeal cases for Medical Director review.
• Process final determinations and complete effectuation activities in accordance with established guidelines.

Kenntnisse

Claims Appeals

Ausbildung

Any Graduation

Jobbeschreibung

Skill required: Claims Appeals - Claims Administration

Designation: Health Admin Services Associate

Qualifications:Any Graduation

Years of Experience:1 to 4 years

What would you do?

• You will be a part of the Healthcare Claims team which is responsible for the administration of health claims
• This team is involved in core claim processing such as registering claims editing verification claims evaluation and examination litigation
• Includes the administration of health, life, and property & causality claims.
  Includes activities involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.

What are we looking for?

• Graduate degree.
  2 to 4 years healthcare operations experience.
  Experience in Medicare Appeals and Grievances processing.
• Experience with Medicare Part C and Part D Appeals.
  Knowledge of CMS regulations and turnaround requirements.

Roles and Responsbilities:

• Handle end-to-end appeals processing, ensuring timely and accurate case resolution.
• Perform AOR (Appointment of Representative) validation and provider outreach.
• Review denial rationales and supporting clinical documentation.
• Prepare and organize appeal cases for Medical Director review.
• Process final determinations and complete effectuation activities in accordance with established guidelines.