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Hiring Claims Adjudicator
Thryve Digital Health LLP1 - 3 years Hyderabad (Telangana)
Screens, reviews, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appropriately. Convert foreign currency to US dollar and code charges appropriately. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Takes the corrective action steps using enrollment, benefit and historical claim processing information. Roles and Responsibilities Determine if claim information is complete and correct. Enter/verify claims data. Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination.Meets all production and quality standards. Attends all required training classes.Elevates issues to next level of supervision, as appropriate.Maintains accurate records, including timekeeping records.Other duties as assigned or requested. Desired Candidate Profile Ability to take direction and to navigate through multiple systems simultaneously.Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.Ability to use mathematics to adjudicate claims.Ability to solve problems within pre-defined methods and guidelines.Knowledge of operating systems specific to claim processing.Perks and Benefits Market Standard
Thryve Digital, with its new headquarters in Chennai, India is one of health cares first global development centres where the best minds in health care technology, science and business create powerful and innovative solutions that transform lives. Solutions that provide the connectivity, sustainability and seamless integration demanded by multi-platform health care systems – every code, every application is infused with the human element, organically nurtured by our passionate team of IT and business process experts who, like our clients lead with their hearts and minds dedicated to improving and providing the best in health care technology – Today and Tomorrow.