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Medical Claims jobs in Bengaluru, Karnataka

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    • Forward high cost amount claims to the medical team for evaluation.
    • Optional Experience: Previous experience in medical insurance.
    • View all ContactPoint 360 jobs - Bengaluru, Karnataka jobs - Claims Processor jobs in Bengaluru, Karnataka
    • Salary Search: Medical Claims Processor Specialist salaries in Bengaluru, Karnataka
    • See popular questions & answers about ContactPoint 360
    • Provides clinical review expertise for high dollar and complex claims, including facility and professional bills.
    • Adheres to quality assurance standards.
    • Managing the escalation related to claims.
    • Communication with the employees regarding their claims.
    • Follow up with the TPA/insurance for the claims.
    • Evaluates medical information against criteria, benefit plan, coverage policies and determines medical necessity.
    • Strong interpersonal and communication skills.
    • Review medical record information to identify all appropriate CPT II procedure coding.
    • Utilize medical coding software programs or reference materials to…
    • Provides clinical review expertise for high dollar and complex claims, including facility and professional bills.
    • MBBS doctor with Oncology experience.
    • The intern will support a claims processing project by entering data and uploading medical provider invoices into a claims management portal, ensuring accuracy…
    • Senior Analyst( Service Support Operation).
    • 3 to 5 year experince in healthcare, insurance , claim.
    • To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical…
    • Handle queries related to claims, eligibility, benefits, billing and insurance.
    • Cab Facility:* Available within applicable company boundaries.
  • View similar jobs with this employer
    • To approve Claims based on the buckets allotted to each approver.
    • To inform the Network department in case of any erroneous billing / excess billing.
  • View similar jobs with this employer
    • Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS guideline along with…
    • Graduate with 3-5 Years Experience in Claims, Insurance and Healthcare (motor and Health).
    • Verify medical claims, data, and references using credible scientific literature.
    • Strong knowledge of medical terminology and life sciences.
    • Process and adjudicate claims as per policy terms and conditions.
    • Handle day-to-day cashless claim-related activities efficiently.

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Medical Claims Processor Specialist
ContactPoint 360
·
4.0
Bengaluru, Karnataka
Full-time
Apply on company site

Job details

Pay information not provided
Full-time
Bengaluru, Karnataka

Full job description

JOB Description : Claims Processor


Summary:


Process healthcare claims and determine the amount of healthcare benefits to be paid to the providers for the given portfolio.


Tasks:


  • Process and adjudicate the claims as per the Table of Benefit of the member


  • Check eligibility of the insured and dependents


  • Check premium status where necessary


  • Check claims as per policy requirements


  • Check provider’s page for bank details and correct Provider -code to use


  • Forward payment notices to Claims Supervisor for validation


  • Check provider agreed tariffs in case of direct billing claims


  • Capture the medical services with the adequate codes (ICD 10 – CPT)


  • Process correct healthcare claims and prior approval agreements within deadlines and as per contract provisions


  • Forward high cost amount claims to the medical team for evaluation


  • Detect any case of abuse or fraud


  • Claims audit targets are being met


  • Ensure daily productivity targets are met as set by management


QUALIFICATIONS

Experience:


  • Optional Experience: Previous experience in medical insurance


  • Experience with ICD-10 and CPT medical coding

  • English a must (German/french good to have)

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