Remote Healthcare Claims Specialist (US Night Shift)

Urgent Opening : SEND YOU RESUME AT [email protected] IMMEDIATE JOINERS ONLY • Associate (US Health Care Claims) /Experienced Only • WORK FROM HOME • MUST HAVE WIFI (100 MBPS SPEED) PACKAGE: UP TO 5LPA Night Shift/US Shift • 5 Days working - Sat and Sun fixed off • Night Shift allowance • Open Position : 20 SUMMARY A Healthcare Complex Claims Specialist is responsible for the thorough investigation, adjudication, and processing of complex healthcare claims in adherence to industry regulations and organizational policies. This role requires a deep understanding of analyzing medical records, healthcare coding systems (e.g., CPT, ICD-10, HCPCS) to accurately assess claims. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. • Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claim processing. • Excellent knowledge of Human Anatomy and medical terminology. • Evaluate claims against established guidelines, contracts, and regulatory requirements. • Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios. • Analyze medical records, policy documents, and other relevant information to make informed claim decisions. • Apply knowledge of healthcare benefits and payment policies. • Provide clear and concise explanations of claim decisions to relevant parties. • Identify trends and patterns in complex claims to contribute to process improvements. • Candidate should be able to correctly calculate claim amounts for the customers. • Complying with company regulations regarding HIPAA, confidentiality, and private health information. QUALIFICATIONS: • Should be Medical graduates (B-Pharma, M-Pharma, BSC or life science graduates). MATHEMATICAL SKILLS: • Should have basic math knowledge of calculating simple interest, compound interest. REASONING ABILITY : • Should have good English comprehension and analytical skills • Should have excellent problem-solving skills with an eye for detail WORK ENVIRONMENT : • Should be open to work 24*7 and mandatory US timings, • Night shift • Ready to handle work pressure and ensure deliverables within timelines Perks: • Complete work from home • Medical insurance • Night Shift allowance