Location: Mumbai

Experience: 1–3 Years
Qualification: Any Graduate
Employment Type: Permanent
Shift: US Shift
Process: Non-Voice
Work Mode: Work From Office (WFO)
Notice Period: Up to 45 Days

Role Overview

We are looking for a Health Admin Services Associate to join the Healthcare Claims Administration team. The role involves handling end-to-end Medicare Appeals and Grievances, reviewing claim denials, validating documentation, coordinating with providers, and ensuring compliance with CMS regulations and turnaround time requirements.

Key Responsibilities

• Manage end-to-end healthcare appeal processing.

• Handle Medicare Part C and Part D Appeals and Grievances.

• Perform Appointment of Representative (AOR) validation.

• Conduct provider outreach for required information and documentation.

• Review claim denial rationale and supporting clinical documents.

• Prepare appeal cases for Medical Director review.

• Process appeal determinations and effectuation activities.

• Ensure compliance with CMS regulations and prescribed turnaround timelines.

• Maintain accuracy and quality while meeting process productivity targets.

Required Skills & Experience

• Any graduate with 1–3 years of relevant healthcare operations experience.

• Hands-on experience in Medicare Appeals and Grievances processing.

• Knowledge of Medicare Part C and Part D Appeals.

• Understanding of CMS regulations and turnaround time requirements.

• Experience in end-to-end appeal processing and AOR validation.

• Provider outreach and coordination experience.

• Ability to review denial rationale and clinical documentation.

• Good communication, analytical, and documentation skills.

Employment Details

• Permanent employment.

• Work from office in Mumbai.

• US rotational shift.

• Non-voice healthcare claims process.

• Candidates with a notice period of up to 45 days can apply.