Inova Care International Hiring for Claims Analyst at Delhi, Delhi Full Time

· Make medical necessity and medical appropriateness determinations for health and dental claims;

· Determine benefit liabilities based on medical necessity, benefit level, member eligibility, waiting periods, pre-existing conditions, exclusions, and coverage;

· Ensure all claims are properly documented and conform to the company’s workflow and documentation requirements;

· Research and resolve misapplied claim payments or provider reimbursements;

· Ensuring all company service level standards are met as it relates to claims analysis and examination;

· Prepares claims report and payment details;

· Make recommendations for process improvements to benefit the company, staff, members, and providers;

· Support customer service-related tasks as needed.

· Apply provider fee schedule and provider discounts properly to all claims;

· Ensure claims are associated with and comply with any prior-authorization or authorization requirement;

· Coordinate with the medical review team for questions regarding medical necessity and medical appropriateness;

· Ensure claims are properly coded and documented before processing;

· Document and report potentially fraudulent provider and member claims to immediate supervisor or manager;

· Submit all approved and processed claims to finance team for liquidation;

· Issue EOB (explanation of benefits) to all members;

· Complete all daily, weekly, monthly, quarterly, and annual management reporting requirements for the scope of responsibilities associated with your position;

· Communication to providers and members for partially denied incomplete or denied claims;

· Ensure all received claims are registered on the same day that the claims are received and are date-stamped accordingly;

· Check claim documents for completeness and report back to the provider or to the member any information or documents that should still be submitted;

· Maintain a clear and precise reconciliation log of all claim documents;

· Assign claim numbers based on the received date and sequence number;

· Ensure all claim documents are scanned and are stored in the appropriate shared folder;

· Reconcile daily received from scanned claim volume, and report any difference to supervisor to properly assess and anticipate task completions;

· Ensure claims are distributed to the appropriate encoders;

· Receive, collate, analyze, and process medical claims;

· Handles inbound and outbound calls and email inquiries from members, providers, and/or clients regarding the claims, appointment, coverage, and eligibility;

· Coordinate with customers and providers to ensure that members can fully utilize the coverage of member’s plan;

· Communicate the business objectives and provide direction to the team and individuals;

· Follow company procedures when handling employee grievances or undertaking disciplinary action;

· Adhere to all policies and procedures that apply to each market;

· Undertake training and development programs of the Management;

· Ensure continuous improvement by constantly identifying and implementing opportunities and processes that improve safe work practices and procedures;

· Be fully aware of the obligations and responsibilities to Occupational Health and Safety;

· Other tasks assigned by management in support of the company’s claims management objectives.

Job Types: Full-time, Contractual / Temporary

Pay: ₹20,000.00 – ₹25,000.00 per month

Schedule:

• Day shift
• Morning shift

Experience:

• total work: 1 year (Preferred)

Work Remotely:

• No