• Responsible for adjudication of the US/Non-US healthcare Claims. and responsible for the coordination and resolution of administrative denials and appeals.• Reviewing claims processing policies and guidelines. Reviewing Physician/Hospital contract for correct payment method.• Ability to understand the logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).• Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data… Show more • Responsible for adjudication of the US/Non-US healthcare Claims. and responsible for the coordination and resolution of administrative denials and appeals.• Reviewing claims processing policies and guidelines. Reviewing Physician/Hospital contract for correct payment method.• Ability to understand the logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).• Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members. Determines actions to be taken on the claim (e.g. pay, decline, request for additional documents)• Reviewing the proper precertification for the claims. Analyzing historical claims for members and providers for correct adjudication.• Meet productivity and quality targets on a daily, weekly, and monthly basis• Process Insurance Claims timely and qualitatively• Review medical documents, policy documents, policy history, Claims history, and system notes and apply the trained client-level business rules to make appropriate Claims decisions, call out claims trends, and flag fraud activities• Claims document validation, calculating benefit amount and releasing same to beneficiary• Use expertise to evaluate the work of others and assist in process calibration• Maintain essential records like working files, and email for reference and audit purposes• Ability to handle basic day-to-day requirements of excel• Handle own work in process and support team efforts to ensure that individual, and team goals are met Show less