Health Admin Services Associate

Skill: Claims Appeals - Claims Administration

Location: Mumbai

Qualification: Any Graduation

Experience: 1-3 years

Notice period: Up to 45 days

Employment: 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.