Job Description

We’re looking for a detail oriented and analytical Claims Senior Retrospective Agent to join our team. The role is responsible for reviewing and reconciling claims data, identifying discrepancies, supporting financial accuracy, and work closely with internal teams and health care providers to resolve claims-related issues.

Key Responsibilities

• 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
  

Job Requirements

• 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.