A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications
Job Summary
A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications.
The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication.
The claims needs to be completed adhering to required TAT and quality SLA.
Matching Summary
A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications.
Skills & Requirements
Must-have
Analyze multiple documents and contracts
Decide to pay or deny claims
Route claims for missing information
Adhere to required TAT and quality SLA
Production and Quality adherence
Shift and Schedule adherence
Nice-to-have
Hyper-focused, domain-centered teams
Cutting-edge tech, data, and analytics
Reimagining traditional outsourcing
Collaborative work environment
Key Requirements
Graduation: Arts & Science/Diploma (Any discipline - 3 years) without arrears