Claims Processing Executive

This is 100% work onsite.

About the Role

Contact end patients and their employers and representatives in the US to gather information to complete the claim. Analyze and evaluate complex claims payments using end Client's proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed and perform accurate and timely data entry. Conduct timely and thorough telephone follow-up with payers and other responsible parties to ensure claims with supporting documentation have been received and facilitate prompt reimbursement. Prepare correct complex claim initial bill packet or appeal letter using the end Client's systems tools and submit with all necessary supporting documentation to insurance companies.

Key Responsibilities

• Contact end patients and their employers and representatives in the US to gather information to complete the claim
• Analyze and evaluate complex claims payments using the Client's proprietary software, systems and tools
• Use payment documentation provided by payers to determine if the medical provider has been reimbursed and perform accurate and timely data entry
• Conduct timely and thorough telephone follow-up with payers and other responsible parties to ensure claims with supporting documentation have been received and facilitate prompt reimbursement
• Prepare correct complex claim initial bill packet or appeal letter using the end Client's systems tools and submit with all necessary supporting documentation to insurance companies
• Assist in obtaining supporting claim documentation, appropriately compiling billing packets, and filing insurance claims
• File and handle confidential documentation and Patient Health Information (PHI); able to adhere and follow all Health Insurance Portability and Accountability Act (HIPAA) mandated guidelines to safeguard data privacy and medical information
• Meet or exceed Client's monthly Quality Audit metric and Production standard targets consistently
• Collaborate well with other TES team members to improve team efficiency
• Assist with operational research by highlighting process areas of improvement

Must Have

• Diploma / Bachelor's Degree in any discipline
• 0-2 years of work experience in US HC BPO
• Strong English communication skills (verbal and written)
• Fast and accurate typing with multitasking
• Attention to detail and professionalism
• Willingness to work on-site, evening shifts

Nice to Have

• US healthcare BPO or claims processing experience
• Knowledge of HIPAA and PHI handling
• Proficiency in MS Office and basic client systems
• Familiarity with billing packets, appeal letters, or insurance documentation