Job description / Role
• Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according to productivity and quality standards.
• Ensures that targets are met for department turnaround time, Quality and Productivity.
• Identify and report back any type of claims observation or issues that may affect the process.
• Collect and analyze claims data to identify and resolve errors, delayed claims, and processing issues. Providing recommendations to take steps to improve the claims processing quality standards and productivity.
• Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management.
• Support the Team leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases.
• Handling medical related call queries.
Skills and Qualification Requirements:
• Should be willing be to work shifts (morning, evening and night shifts)
• Must be an MBBS Graduate
• Candidates able to start immediately preferred
• Medical license not required
• 2 years minimum clinical experience
About the Company
IRIS HEALTH SERVICES LLC, is an ISO 9001:2008 and ISO 27001:2013 Certified Third Party Administration Service Company providing professional medical benefit and claims administration services.
IRIS HEALTH with the strength of its team, experience and expertise provides an unparalleled end to end claims management solution. It's not just about claims processing but rather about managing medical claims.
Our cutting edge software platform fundamentally changes the dynamics of managing medical portfolios. As a result, our Clients benefit from many features that provide unparalleled efficiency that includes managing your medical claims, trend analysis and monitoring.