US Healthcare Claims Processor - Navi Mumbai

Position Overview

Hexaware Technologies invites applications for the role of US Healthcare Claims Processor based in Navi Mumbai. The role entails managing healthcare claims with a focus on accuracy, compliance, and efficiency within a five-day workweek schedule. Employees will benefit from transportation support via a one-way drop service within company-defined geographical boundaries.

Core Duties and Responsibilities

• Inspect incoming claims for health services to ensure all documentation is correct and complete for proper adjudication.
• Evaluate claims in accordance with payer guidelines, contracts, and applicable healthcare regulations to decide on payment approvals or rejections.
• Liaise with healthcare providers, policyholders, and internal departments to clarify discrepancies or obtain supplementary details when necessary.
• Effectively use claims processing software for recording, updating, and retrieving claims information.
• Detect and alert instances or patterns suggesting fraudulent activities, wastefulness, or misuse related to claims.
• Ensure timely processing of claims while maintaining precision and efficiency standards.
• Work collaboratively with colleagues to enhance adjudication processes and meet team goals.
• Keep abreast with the latest healthcare regulations, payer policies, and industry best practices through continuous learning.

Required Qualifications and Skills

• Experience working in US Healthcare Claims Processing or Claims Adjudication.
• Strong abilities in analysis and problem resolution.
• Effective communication and interpersonal skills.
• Capability to maintain high accuracy in a fast-moving work environment.
• Familiarity with claims processing platforms and associated software.

Additional Details

• Work Location: Navi Mumbai
• Work Schedule: 5-day workweek
• Transportation: One-way drop facility within company limits
• Eligible Applicants: Any graduate