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Adjudication associate is responsible for timely and accurate payment of Medical Bills submitted by US based hospital and doctors. The process includes claim adjudication, checking compensability, invoice review and the validation of the details in other systems and determine/decide on the accuracy of the amount billed and/or the need for denial of the claim based on result of research. Associate would also need to liaise with claims handlers on need basis.
Responsibilities
Ensure that the process transactions are processed as per Desktop procedures
Ensure that the assigned targets are met in accordance with SLA and Internal standards
Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
Ensure adherence to established attendance schedules
Managing calendars and e-mails
Qualifications
Graduation (any stream) or diploma with a minimum of 15 years of education