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Health Insurance

0.00 to 2.00 Years   Delhi   15 Jun, 2023
Trenz Management Services
Job LocationDelhi
EducationNot Mentioned
SalaryNot Disclosed
IndustryInsurance
Functional AreaAllied Health Services
EmploymentTypeFull-time

Job Description

    What does a Health Insurance Specialist do Health insurance specialists provide expertise about health insurance programs, regulations, procedures, and legislative updates. They are commonly employed by medical practitioner groups, healthcare facilities, or government agencies. They analyze and process contracts and other documents, develop compliance and audit procedures, and prepare reports and other materials. They monitor critical policy changes and confirm any necessary adjustments are implemented to ensure compliance. They may also perform tasks related to coverage verification and obtaining prior authorizations.Health insurance specialists typically have a bachelors degree in a business field, but significant professional experience related to health insurance may be acceptable as a substitute. They must have extensive knowledge of regulations and procedures related to private insurance and government programs such as Medicaid and Medicare. These roles require good computer skills and proficiency with common office software programs.What responsibilities are common for Health Insurance Specialist jobs
    • Processes credit card payments and posts payment to the appropriate account.
    • Other duties and projects will be assigned as needed.
    • Answer telephone billing inquiries from customers, outside sources and in-house personnel.
    • Perform various follow up activities including telephone calls, appeals, letters and utilizes payer websites to achieve timely resolution.
    • Partner with the appropriate staff and departments to ensure optimal working relationships.
    • Prepare refund requests or forward to appropriate person depending on department/area.
    • Review accounts to be considered for write off due to exhausted follow up efforts and time limits.
    • Review accounts with balances that were a result of incorrect payer payments/adjustments.
    • Ensure compliance with quality assurance and productivity department goals specific to main job responsibilities for each area of the business office.
    • Maintain skill proficiency, including improvement where deemed necessary, and upgrading any additional or new skills on the appropriate position skills list.
    • Assist customers to make health care decisions by carefully matching customers with the optimal products and services.
    What are the typical qualifications for Health Insurance Specialist jobs
    • Bachelors or Graduates Degree in business, business administration, computer science, engineering or management.
    • Sound leadership and problem solving capabilities.
    • Proven record of attention to detail, time management, and multitasking skills.
    • Fluent in insurance process, including negotiation, reserving, and liabilities.
    • Fluency in a variety of programs, software, and systems such as C#, GS-13, MVC, and R Language.
    • Experienced in delegated examining.
    • Fluent in working with clients to select proper plans and arranging for signups

Keyskills :
life insuranceinsurance

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