Senior Process Executive-Data

Job Summary

We are seeking a dedicated Senior Process Executive - HC with 3 to 5 years of experience in Claims Adjudication. The ideal candidate will work from our office during night shifts ensuring the accurate and timely processing of claims. This role is crucial in maintaining the efficiency and reliability of our claims operations directly impacting customer satisfaction and operational excellence.

Responsibilities

• Process claims accurately and efficiently ensuring compliance with company policies and regulatory requirements.
• Review and adjudicate claims based on established guidelines and procedures.
• Identify discrepancies and resolve issues related to claims processing.
• Collaborate with team members to ensure seamless workflow and timely completion of tasks.
• Maintain up-to-date knowledge of industry standards and changes in claims adjudication processes.
• Provide feedback and suggestions for process improvements to enhance operational efficiency.
• Utilize technical skills to analyze and interpret claims data for accurate adjudication.
• Ensure all claims are processed within the stipulated timeframes to meet service level agreements.
• Communicate effectively with internal and external stakeholders to resolve claims-related queries.
• Document all actions taken on claims in the system for future reference and audit purposes.
• Participate in training sessions to stay updated on new policies and procedures.
• Support the team in achieving overall departmental goals and objectives.
• Contribute to the companys mission by ensuring high-quality claims processing that enhances customer trust and satisfaction.
  
  

Qualifications

• Possess a minimum of 3 years of experience in Claims Adjudication.
• Demonstrate strong analytical skills to accurately process and adjudicate claims.
• Exhibit excellent communication skills for effective stakeholder interaction.
• Show proficiency in using claims processing software and tools.
• Have a keen eye for detail to identify and resolve discrepancies in claims.
• Display the ability to work efficiently in a night shift environment.
  
  

Certifications Required

Certified Professional Coder (CPC) or equivalent certification in claims adjudication.