HC and Insurance Operations Analyst

In this Role you will be Responsible For :

Review & Processes Healthcare payer claims including HCFA & UB forms.
Validate Member, Provider and other Claims information. 
Resolve multiple hold codes/edits to complete a transaction
Need to verify and understand the healthplan documents to take decision on benefits allowed
Strong knowledge on all claims type like COB, corrected submission etc.
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
Ensuring accurate and timely completion of transactions to meet or exceed client SLAs 
Organizing and completing tasks according to assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Resolving complex situations following pre-established guidelines
  
Requirements for this role include:
 
•    1.5 to 3 years of experience in a BPO handling Healthcare adjudication process in CPS claims platform.
•    University degree or equivalent that required 3+ years of formal studies is a must to apply
•    Ability to communicate (oral/written) effectively in English to exchange information with our client.
•    1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
•    Ability to work scheduled shifts from Monday-Friday 06:00 PM to 04:00 AM (weekend’s if required) and to be flexible to accommodate extra hours due to business requirements