Senior Process Executive - HC

Job Summary

We are seeking a Senior Process Executive - HC with 2 to 6 years of experience in Claims Adjudication. The ideal candidate will have a strong background in healthcare processes and will be responsible for ensuring the accuracy and efficiency of claims processing. This role is work from home with a day shift schedule and no travel is required.

Responsibilities

• Oversee the claims adjudication process to ensure timely and accurate processing of claims.
• Provide expertise in handling complex claims and resolving discrepancies.
• Collaborate with team members to streamline processes and improve efficiency.
• Ensure compliance with healthcare regulations and company policies.
• Monitor and analyze claims data to identify trends and areas for improvement.
• Communicate effectively with internal and external stakeholders to resolve issues.
• Maintain up-to-date knowledge of industry standards and best practices.
• Utilize technical skills to enhance claims processing systems and tools.
• Support the training and development of junior team members.
• Participate in continuous improvement initiatives to optimize claims adjudication workflows.
• Document and report on claims processing activities and outcomes.
• Contribute to the development and implementation of process improvements.
• Ensure a high level of customer satisfaction through effective claims management.
  
  

Qualifications

• Possess strong technical skills in claims adjudication with a minimum of 2 years of experience.
• Have experience in medical management and payer domains is a plus.
• Demonstrate excellent analytical and problem-solving abilities.
• Exhibit strong communication and interpersonal skills.
• Show proficiency in using claims processing software and tools.
• Display a keen attention to detail and accuracy.
  
  

Certifications Required

Indian Registered Nurse