We are hiring for Claim Analyst Role for a blended process who will be handling claims related calls and emails. It will be a 24*7 hours (365 Days) process, wherein associate with be coordinating with NRI customers.
Responsibilities:
Handle property claims, limited in scope, based on claims guidelines.
Research, create, and maintain all reimbursement related information and data to ensure regulatory compliance.
Follow all policies and procedures established for the department.
Answer client/patient questions to ensure understanding and client/patient satisfaction, or refers them to more senior level staff.
Analyze and process claims in accordance with plan provisions.
Develop and maintain strong business relationships with internal and external customers.
Manage reserve adjustments and payments to avoid deficit payments.
Maintain compliance with claim routing and inventory control procedures.
Oversee advanced claim inquiries and assist claims staff with responding appropriately as needed.
Calculate monthly contractual allowances, post journal entries, and explain variances to budget and prior periods.
Document, track and resolve all plan providers' claims projects.
Adhere to all statutory and regulatory fair claims practices.
Assist in the maintenance of the guidelines for the processing of specialty accident and health insurance claims.