Job Description

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  Review and analyze claims to ensure they are accurate and complete.
• Process claims adjustments and corrections as necessary.
• Reconcile claims data with financial records and systems.
• Identify and investigate discrepancies in claims transactions and ensure timely and accurate reconciliation of claims.
• Analyze claims data to identify trends and patterns.
• Prepare reports and presentations on claims performance and reconciliation outcomes.
• Utilize data analytics tools to improve the efficiency of the claims reconciliation process.
• Assist in internal and external audits related to claims and reconciliation.
• Maintain accurate and organized documentation for audit purposes.
• Work closely with the finance, processors, and customer service departments to resolve claims issues.
• Communicate effectively with stakeholders to address and resolve claims discrepancies.
• Handle and support direct communication with the healthcare providers on their rejection ratio and reconciliation review findings.
• Conduct Reconciliation meetings with the stakeholders as required by the reconciliation process.
• Other Ad hoc duties as required
• AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.
  

What You Bring

• Bachelor’s degree in any Medical field, Finance, Business Administration, Insurance, or a related field preferred.
• Minimum of 2-3 years of experience in claims reconciliation, financial analysis, or a similar role.
• Experience in the insurance or healthcare industry is preferred.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Excel and other data analysis tools.
• Excellent attention to detail and accuracy.
• Strong organizational and time management skills.
• Ability to work independently and as part of a team.
• Excellent written and verbal communication skills.
• Familiarity with claims processing systems and software.
• Understanding of regulatory requirements related to claims and reconciliation.
• Knowledge of accounting principles and practices.
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.