Executives

Position

Executive, Medbill Adjudication

Function, Responsibility Level

Operations, Executive

Reports to

Assistant Manager, Adjudication

Span of Control

Nil

Location

Pune

Permanent/ Temporary

Permanent

Adjudication associate is responsible for timely and accurate payment of Medical Bills submitted by US based hospital and doctors. The process includes claim adjudication, checking compensability, invoice review and the validation of the details in other systems and determine/decide on the accuracy of the amount billed and/or the need for denial of the claim based on result of research. Associate would also need to liaise with claims handlers on need basis.

Essential Functions

. Ensure that the process transactions are processed as per Desktop procedures

. Ensure that the assigned targets are met in accordance with SLA and Internal standards

. Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence

. Ensure adherence to established attendance schedules

. Managing calendars and e-mails

Performance parameters

. Productivity

. Quality / Accuracy

. Attendance

. Schedule Adherence

Any other essential function that may occur from time to time as directed by the Supervisor

Primary Internal Interactions

. AM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.

. Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance

. CCEs (Team Members) for the purpose of seeking cooperation & clarification on process-related matters & providing assistance and support when required

. Subject Matter Expert for the purpose of work thread related issues and escalated transactions

. QCA for the purpose of feedback and audit

. Trainers for the purpose of Pre-process and Process training

Primary External Interactions

. Escalation teams at the client end for the purpose of seeking clarifications & answering queries

. SME / Trainers at the client end for training