HC & Insurance Operations Associate

Roles and Responsibilities: * Process Adjudication claims and resolve for payment and Denials * Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process * Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations * Ensuring accurate and timely completion of transactions to meet or exceed client SLAs * Organizing and completing tasks according to assigned priorities. * Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team * Resolving complex situations following pre-established guidelines Requirements: * 1-3 years of experience in processing claims adjudication and adjustment process * Experience of Facets is an added advantage. * Experience in professional (HCFA), institutional (UB) claims (optional) * Both under graduates and post graduates can apply * Good communication (Demonstrate strong reading comprehension and writing skills) * Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.