Senior Claims Examiner

Synthesis Healthcare Services LLP

Chennai, Tamil Nadu, India

Adjudication Experienced

Any graduate.

Having 1-5 years experience in HCFA/UB claim processing.

Having good exposure to CMS processing guidelines.

Good Analytical skills.

Good communication skills.

Working knowledge of MS office tools.

Willing to work in any shift.

Responsible for the coordination and resolution of the administrative denials and appeals.

Ability to understand logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).

Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.

Meet & Exceed Production, Productivity, and Quality goals

Process Insurance Claims timely and qualitatively

Review medical documents, policy documents, policy history, Claims history, and system notes and apply the trained client-level business rules to make appropriate Claims decisions, call out claims trends, and flag fraud activities

Eligible Criteria

Any... More Detail

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