PE-Claims HC

Job Summary

We are seeking a detail-oriented and motivated individual for the role of PE-Claims HC. The candidate will be responsible for processing Medicare and Medicaid claims with precision and efficiency. Proficiency in MS Excel and claims adjudication is essential. This is a night shift work-from-office role requiring strong English communication skills.

Responsibilities

• Process Medicare and Medicaid claims with a high level of accuracy and adherence to regulatory guidelines.
• Utilize MS Excel to analyze organize and validate claims data for efficient processing.
• Ensure timely adjudication of claims while maintaining compliance with company and industry standards.
• Identify discrepancies in claims and take corrective actions to resolve them effectively.
• Collaborate with internal teams to ensure seamless claims processing and issue resolution.
• Maintain up-to-date knowledge of Medicare and Medicaid policies and procedures to ensure compliance.
• Provide detailed documentation of claims adjudication processes and outcomes for audit purposes.
• Communicate effectively with stakeholders to clarify claim-related queries and provide resolutions.
• Monitor claims workflow to ensure deadlines are consistently met without compromising quality.
• Support the team in identifying process improvement opportunities to enhance operational efficiency.
• Adhere to data privacy and confidentiality standards while handling sensitive claim information.
• Participate in training sessions to stay updated on industry trends and software tools.
• Contribute to the companys mission of delivering exceptional service and improving healthcare outcomes.
  
  

• Possess strong proficiency in MS Excel including functions such as data analysis and reporting.
• Demonstrate expertise in claims adjudication processes ensuring accuracy and compliance.
• Have a solid understanding of Medicare and Medicaid claims including regulatory requirements.
• Exhibit excellent English communication skills both written and verbal for effective collaboration.
• Show attention to detail and problem-solving skills to handle complex claim scenarios.
• Display the ability to work efficiently in a night shift work-from-office environment.