Subject matter expert in health insurance & dependent care claims process for USA.Including:
- Claims Process Validation
- Overpayment Identification
- Quality Audit
- Good basic mathematics, reasoning, and interpretation skills
- Working knowledge of MS Excel/Access/Power Point
- Basic understanding of SQL and VBA
- Experience in reporting and data analysis
- Behavioural/ Leadership Skill
- Logical skills
- Self-motivated and energetic attitude
- Identifying overpayment opportunities by:
- Reviewing claims processing policies and guidelines.
- Reviewing provider contracts.
- Analysing historical overpayment trends.
- Analysing claims data to identify outliers.
- Contribute toward team's yearly target of overpayment identification.
- Review and validate claims.
- Assist team members and as and when required.
- Maintain and track overpayment projects in organized and timely manner.
- Adhere to all client and company policies without exceptions.
- Adjudication, Indexing, Claim processing of Healthcare, Dependent care & Workflow management