AIOC-S01672238 | Health Admin Services Associate
Client: Accenture
Skill: Claims Appeals - Claims Administration
Location: Mumbai
Qualification: Any Graduation
Experience: 1-3 years
Notice period: Up to 45 days
Annual CTC: INR 10 lakh to INR 15 lakh (10-15 LPA)
Employment: Permanent
Shift: US shift
Process: Non-voice
Work mode: Work from office

ABOUT ACCENTURE
Accenture is a global professional services company with capabilities in digital, cloud and security, offering Strategy and Consulting, Technology and Operations services, and Accenture Song across more than 40 industries. Visit www.accenture.com.

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.