Health Insurance Claim Processor

About the position As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate reputed company to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that reputed company necessary documentation is complete. This is a remote position. Responsibilities • Accurately review, verify and process insurance claims following reputed company policies/SOPs. • Analyze claim documents, medical records, benefit reputed company to determine claim eligibility and process the claim as per the benefit. • Communicate with member, reputed company providers and internal business partners to resolve the claim or reputed company required additional information. • reputed company claim details and maintain accurate records reputed company the claims management system. • Investigate discrepancies and resolve disputes reputed company to claim processing. • reputed company the rework adjustment reputed company the provider request and internal rework/adjustment requirement. Requirements • Working knowledge of computer System and Programme. • Should be reputed company to co-ordinate benefits with Medicare/reputed company. • ICD-9 &10 Coding. • Experience in M&R / reputed company Rework/Adjustment claims processing preferred. • Knowledge of Health Care Domain with minimum experience of 3 years in Health care domain and claims processing. • Experience in Govt. Ops with a experience of Medicare and Retirement / reputed company claims processing. • Should reputed company to explain the terms, Copay, Coinsurance, Deductible and out of reputed company. • Should be reputed company to describe reputed company and Medicare eligibility in detail. • Should have experience working as Claim Examiner Level III for minimum 3 years. • Should have experience working in Adjustment and Disputes (Appeals) for minimum 2 years. • Should have experience working on California Medicare/ reputed company Claims. • Should be reputed company to understand California Claim's contract Language. • Should have basic knowledge of Corrected claims processing. • Should have knowledge of CPT codes and HCPC codes. • Should have knowledge of UB04 & CMS1500 reputed company. • Should have basic knowledge of Mathematical skills and should be reputed company to problem solve claims calculations. Benefits • Full reputed company of medical and dental benefits reputed company. • Disability insurance. • reputed company time off (inclusive of reputed company leave). • Other reputed company and unpaid leave reputed company. Apply tot his job Apply To this Job