Skill required: Claims Appeals - Claims Administration
Designation: Health Admin Services Associate
Qualifications:Any Graduation
Years of Experience:1 to 3 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 Responsibilities:

• 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.

Qualification: Any Graduate (Any Stream).