HEALTH ADMIN SERVICES ASSOCIATE – CLAIMS APPEALS (AIOC-S01672238)

JOB DETAILS

Job ID: AIOC-S01672238

Job Title: Health Admin Services Associate

Client: Accenture

Skill: Claims Appeals – Claims Administration

Work Location: Mumbai

Qualification: Any Graduation

Experience: 1–3 years

Notice Period: Up to 45 days

Employment Type: Permanent

Shift: US Shift

Process: Non-Voice

Work Mode: Work from Office

---

ROLE OVERVIEW

Join the Healthcare Claims team responsible for health claims administration, including claims registration, editing and verification, evaluation, examination and litigation-related support.

The broader claims administration scope includes health, life, and property and casualty claims.

---

REQUIRED SKILLS AND EXPERIENCE

Graduate in any discipline with 1–3 years of relevant 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.

Experience in end-to-end appeal processing, AOR validation and provider outreach.

Ability to review denial rationale and supporting clinical documentation.

---

ROLES AND RESPONSIBILITIES

Handle end-to-end appeal processing.

Perform AOR validation and provider outreach.

Review denial rationale and supporting clinical documentation.

Prepare cases for Medical Director review.

Process determinations and effectuation activities.

Follow applicable CMS regulations and turnaround requirements.