US Healthcare Claims /Appeals -Associate/Analyst

Skill required: Claims Appeals - Claims Administration

Designation: Health Admin Services Associate

Qualifications:Any Graduation

Years of Experience:1 to 4 years

What would you do?

• You will be a part of the Healthcare Claims team which is responsible for the administration of health claims
  
• This team is involved in core claim processing such as registering claims editing verification claims evaluation and examination litigation
  
• Includes the administration of health, life, and property & causality claims.
  • Includes activities involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.
  

What are we looking for?

• • Graduate degree.
  • • 2 to 4 years healthcare operations experience.
  • • Experience in Medicare Appeals and Grievances processing.
  
• • Experience with Medicare Part C and Part D Appeals.
  • • Knowledge of CMS regulations and turnaround requirements.

Roles and Responsbilities:

• Handle end-to-end appeals processing, ensuring timely and accurate case resolution.
• Perform AOR (Appointment of Representative) validation and provider outreach.
• Review denial rationales and supporting clinical documentation.
• Prepare and organize appeal cases for Medical Director review.
• Process final determinations and complete effectuation activities in accordance with established guidelines.