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Process Developer - Claims Adjudication

2.00 to 7.00 Years   Noida   02 Dec, 2022
Genpact India Pvt Ltd
Job LocationNoida
EducationNot Mentioned
SalaryNot Disclosed
IndustryIT - Software
Functional AreaGeneral / Other SoftwareSales / BD
EmploymentTypeFull-time

Job Description

    Transaction processing according to standard work & SOP o Validation of information entered by indexer o Verify coverage; evaluate eligibility and process payment/denial based on policy coverage o Maintain appropriate documentation on all claim files and process claims in a timely manner o Research, analyze, and interpret policy language and state law as it relates to submitted claims o Interact with various online systems for claims processing, imaging and policy administration o Build broad understanding of company s products & systems o Identify duplicate Claims and take appropriate action o Identify Front End Savings by investigating claims to Identify any over charge, ineligible chargers, contract compliance, Provider or Member Fraud Ability to understand the process requirements Provide email support to troubleshoot and resolve issues experienced during processing Prioritize transactions according to documented guidelines to meet SLA Plans and organizes tasks and work responsibilities to achieve objectives Comprehending and responding to customer inquiries. Identify, research, and resolve problems. Assist with/perform other team tasks as required. Ability to accurately interpret and compile information from a variety of sources and systems Ensure that turnaround time and quality of the work meets Company service standards Get along with Onshore /Offshore and customer in a supportive and professional manner via email and on calls Manage own work in process and support team efforts to ensure that individual, team goals are met. Maintain key records like working files, email for reference and audit purpose Should be able to handle basic day to day requirements of excel Qualifications: Graduation in any stream except B.Tech and Technical Graduation & Law Essential skills: Proven Claims operations experience for Life, Accident and Health, Disability Insurance Exposure to Insurance claims operations - Claims Adjudication Good English Communication (Both written & verbal) Proactive communication & High analytical skills should be able to foresee issues and suggest solutions, with impactful data Displays energy and passion in approaching the job Must have decision making capability while processing Ability to work under pressure and meet deadlines, while maintaining a positive attitude and providing outstanding customer service Good in MS Excel Should be able to do MIS reporting / report outs Ready to work on stretched working hours Ability to independently get along with internal and external customers Focus on Customer happiness Basic Computer knowledge along with typing speed of 25 words/minute Insurance knowledge,

Keyskills :
sapaccountsaccountingcustomer relationsbasishigh analytical skillsfront endtyping speedmis reportingemail supportstandard workcustomer focus

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