Job Description

Senior Associate - Claims Analyst

Mumbai (Mindspace, Airoli / Powai)

Current Work Experience
3 to 5 years

Skills (mandatory)
  • Ability to analyze and resolve health services claims and related problems
  • Ability to troubleshoot claims data issues
  • Understands claims processing and is able to interpret the information in a claim file
  • Strong SQL Skills (Microsoft SQL Server)
  • Elicit requirements using document analysis, requirements workshops, surveys, and business process descriptions  
  • Proactively communicate and collaborate with external and internal customers
  • Possess a good knowledge of claims eligibility and validation processes
  • Knowledge of automated utilization review, specialty benefit management and data analysis systems
  • Excellent verbal & written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts
Skills (desired)
  • Good understanding of US healthcare and latest regulatory advances
  • Excellent understanding of ICD9-ICD10 coding and other medical coding standards such as CPT codes, HCPCS coding etc.
  • Understands Medical coding, billing & payments and provider contracting processes
  • Knowledge of health care standards appropriate to specific claim
  • Experience of medical, pharmaceutical, and other health services, practices, and terminology
  • Knowledge of medical reimbursement policies, procedures and standards
  • Knowledge of health care billing standards and procedures
  • Analyze and understand claim files coming in electronic and other formats
  • Work with the business users and technical team to facilitate onboarding of a new client, modifications to existing plans etc.
  • Help the data loads engineers for correct mapping of claims data to ensure successful loads
  • Assist team to troubleshoot issues with data loads by ensuring correctness of claims data
  • Work with business users to understand data and reporting needs, liaise with data developers to provide or load data as per business needs
  • Periodically monitor quality of data and provide data quality reports to Analytics Managers and Business users

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or call us at +1 (877) CITIUS1