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Health Operations Associate - Healthcare Claims
Mumbai
Job No. aioc-s501157
Full-time
Job Description
Skill required: Claims Services - Payer Claims Processing
Designation: Management Level - Associate
Qualifications:Any Graduation,BMM,BMS
Years of Experience:1 to 3 years
About Accenture
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
What would you do? The Healthcare Operations vertical helps our clients drive breakthrough growth by combining deep healthcare delivery experience and subject matter expertise with analytics, automation, artificial intelligence and innovative talent. We help payers, providers and government agencies increase provider, member and group satisfaction, improve health outcomes and reduce costs. You will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation. In Payer Claims Processing you will be responsible for delivering business solutions that support the healthcare claim function, leveraging a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims.
What are we looking for? Ability to manage multiple stakeholders • Strong analytical skills • Written and verbal communication • Prioritization of workload • Attention to detail • Ready to work in evening shift • Client communication skill • Conveys information clearly and effectively both written and verbal • Ability to work independently • MSOffice like excel, word, ppt knoweldge • Ability to prioritize and multi-task • Good communication skills • Able to work on reports • Analytical • Experience with claims processing • Experience in Medicare Claims processing • Proficient in Claims - Appeals and Grievances process • Complete understanding with Claims Adjustments – exposure to over and under payments • Strong ability to understand complex claims documentation in relation to Appeals/Grievances/Disputes • Experience in reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing) • Claims review and/or member dispute resolution • HRP Experience • Escalation Management experience • HRP Experience • Escalation Management experience • US Healthcare Claims Processing Experience
Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems • Your day to day interaction is with peers within Accenture before updating supervisors • In this role you may have limited exposure with clients and/or Accenture management • You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments • The decisions you make impact your own work and may impact the work of others • You will be an individual contributor as a part of a team, with a focused scope of work • Please note that this role may require you to work in rotational shifts
Designation: Management Level - Associate
Qualifications:Any Graduation,BMM,BMS
Years of Experience:1 to 3 years
About Accenture
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
What would you do? The Healthcare Operations vertical helps our clients drive breakthrough growth by combining deep healthcare delivery experience and subject matter expertise with analytics, automation, artificial intelligence and innovative talent. We help payers, providers and government agencies increase provider, member and group satisfaction, improve health outcomes and reduce costs. You will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation. In Payer Claims Processing you will be responsible for delivering business solutions that support the healthcare claim function, leveraging a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims.
What are we looking for? Ability to manage multiple stakeholders • Strong analytical skills • Written and verbal communication • Prioritization of workload • Attention to detail • Ready to work in evening shift • Client communication skill • Conveys information clearly and effectively both written and verbal • Ability to work independently • MSOffice like excel, word, ppt knoweldge • Ability to prioritize and multi-task • Good communication skills • Able to work on reports • Analytical • Experience with claims processing • Experience in Medicare Claims processing • Proficient in Claims - Appeals and Grievances process • Complete understanding with Claims Adjustments – exposure to over and under payments • Strong ability to understand complex claims documentation in relation to Appeals/Grievances/Disputes • Experience in reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing) • Claims review and/or member dispute resolution • HRP Experience • Escalation Management experience • HRP Experience • Escalation Management experience • US Healthcare Claims Processing Experience
Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems • Your day to day interaction is with peers within Accenture before updating supervisors • In this role you may have limited exposure with clients and/or Accenture management • You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments • The decisions you make impact your own work and may impact the work of others • You will be an individual contributor as a part of a team, with a focused scope of work • Please note that this role may require you to work in rotational shifts
Qualifications
Any Graduation,BMM,BMS
Please be informed that at any given point in time, you can only have one "Active" application.
Please be informed that at any given point in time, you can only have one "Active" application.