Spe/sme/claim Adjudication/medical Coder/manual Claims / Apac
- Cognizant
- 2 - 4 years
- Coimbatore
- 2 days ago
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Job Description
APAC Experience (Manual Claims)
Mandatory Pointer
- SPE and SME -25 open numbers (Exp.2-6years) Location-Coimbatore.
- Apac Region Experience candidates only .
- Target companies like - NLGIC, Star Health, Galaxy,etc.
- Manual Claims Adjudication experience
Job Description
- Assess complex medical claims similar to AXA, AIA, Alliance Care
- Verify medical codes, diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9, ICD 10, CPT)
- Review Clinical & Day Case claims and approve/reject basis the SOP
- Review Hospital Inpatient & Outpatient Claims, analyze the vouchers/medical documents, categorize the benefits as per the SOP and approve/reject basis the SOP
- Provide guidance and support to facilitate junior advisors resolve complex claims
- Identify potential fraud, waste, and abuse (FWA) Flag suspicious cases, highlight patterns, and work with compliance teams to ensure early detection and escalation.
Questionnaire
Q1. What is Insurance Claim ?
Q2. What are the Steps of Claim used in Apac Region ?
Q3. What is your understanding about the Manual Claims adjudication ?
Q4. What is ICD9 and ICD10 give detailed answer on the same with examples of the work done by them, the basic codes used universally needs to be mentioned correctly?
Q5. Give an example of correct Diagnosis Interpretation?
Valid PAN Number - _____________________(Why PAN Required > Mandatory to Process Candidature & Find Duplicity in Internal PAN Validation Process and also to initiate a screening call.
Please reach out in case of any queries.
Sonali Chattopadhyay I Associate People Success
Orcapod Consulting Services Pvt Ltd.
Email I so*****************y@or****d.work
www.orcapodservices.com
9548431***
Job Classification
Industry: BPM / BPOFunctional Area / Department: BFSI, Investments & TradingRole Category: Banking OperationsRole: Banking Operations - OtherEmployement Type: Full timeContact Details:
Company: CognizantLocation(s): Coimbatore
Keyskills: diagnose interpretation manual claims Claims Adjudication Medical Coding review clinical APAC
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