Senior Analyst - Claim Operations

Overview

Minimum 3 years of experience in US Healthcare employee benefit claims Proven track record of successful claim resolutions and customer satisfaction. Strong knowledge of US Healthcare insurance regulations, policies, and procedures. Hands on experience in approving EB claims like Dental, physiotherapy and other procedures Confirm patient insurance coverage, deductibles, and eligibility against policy guidelines. Calculate the correct reimbursement amount to issue payments or formally deny/pend invalid claims. Perform Employee benefit determination and pay/deny decisioning per plan rules Communicate with healthcare providers, patients, and internal departments to resolve discrepancies. Follow federal/state regulations and guidelines to protect sensitive patient information (HIPAA). Mitigate organizational risk, maintaining compliance and reputation How you'll make an impact Hands on experience in approving EB claims like Dental, physiotherapy and other procedures Confirm patient insurance coverage, deductibles, and eligibility against policy guidelines. Calculate the correct reimbursement amount to issue payments or formally deny/pend invalid claims. Perform Employee benefit determination and pay/deny decisioning per plan rules Communicate with healthcare providers, patients, and internal departments to resolve discrepancies. Follow federal/state regulations and guidelines to protect sensitive patient information (HIPAA). Mitigate organizational risk, maintaining compliance and reputation About you Qualifications: Bachelor’s degree in insurance or related field Certificate(s)/Special Training: Insurance industry certifications – AIC, AINS, Cert CII or any other relevant Insurance certification