Executive – Claims Management, Medical Billing and Claims Processing
EXL
full-time
Posted on:
Location Type: Hybrid
Location: Noida • 🇮🇳 India
Visit company websiteJob Level
JuniorMid-Level
About the role
- Responsible to reprice the non-par claims as per the Fee schedule and payment methodology.
- Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language.
- Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information.
- Provide input for new process development and continuous improvement.
- Supplier will share daily production report with stateside manager for review and feedback.
- Maestro Health will provide all applications and accesses required for claim repricing.
- Access requests should be completed within first week of project start date in order to start production.
Requirements
- Graduate in stream preferred science stream 1 - 2 Years
- Expertise in using Claim processing and validation application and worked in past on same profile/portfolio.
- Basic level proficiency on Excel to query production data and prepare/generate reports.
- Analytical mindset with strong problem solving skills.
- US Healthcare insurance domain experience desirable
- Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes.
Benefits
- Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier.
- Requirement gathering & training session will require active participation from Maestro Health manager.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claim processingvalidation applicationreimbursement calculationsExceldata queryingreport generationmedical claims reviewfee schedulepayment methodologycontinuous improvement
Soft skills
analytical mindsetproblem solvingcommunication