Claims Specialist

Hi All,

Kindly have a glance at the below requirement and send me your consultant's updated word copy of resume, contact details and competitive rate ASAP if he/she is a good fit.

Please submit the resumes to munna@anjaneyap.com

 

Note : For Process associates we need people who have lead claims and Enrollment business operations for a health plan.

 

Claims Specialist

Indianapolis, IN

6 Months

 

Job responsibilities –

 

•             Responsible for directing the planning, design, development, implementation and evaluation of policies and procedures that assure accurate, timely claims and encounter processing and provider inquiries (written or verbal).

•             The compilation of all information and documents required for claims and encounter processing and related inquiries to assure compliance with all applicable rules, regulations, and external and internal policies and procedures

•             Development and maintenance of well-defined processes and standard operating procedures (SOPs) to enter, adjust, manage and report claims and encounters data

•             Generation of configuration requests to assure accurate, timely administration of providers claims and processing and reporting of encounters

•             Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts

•             Analyze, track and trend claims and encounters data; identify any potential service or systems issues; implement interventions, and determine success of intervention

•             Up to 30% travel

 

 

Skillset-

 

•             BA/BS degree preferred with at least Six (6) years of relevant professional experience in Healthcare claims operations for a large national/regional/blue plan

•             Excellent business analysis skills

•             Extensive experience in developing standard operating procedures (SOPs) and processes for Healthcare claims operations.

•             Excellent verbal and written communication skills

•             Extensive knowledge of claims policies and procedures, including industry standards from CMS, and CCI Edits.

•             Knowledge of clinical editing, code sets, medical policies

•             Highly developed quantitative and qualitative analytical skills.

•             Proficiency with MS Office applications, especially word, excel, visio

Thanks

munna

munna@anjaneyap.com

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