Sr. Associate OPD claims

About the Role at ACKO

The Medical Claim Processor is responsible for end-to-end processing of medical insurance claims (reimbursement), ensuring accuracy, compliance with policy terms, and adherence to turnaround time (TAT). This role requires close coordination with hospitals, customers, internal teams, and third-party administrators to deliver timely and efficient claim settlements.

The Medical Claim Processor plays a critical role in ACKO by ensuring seamless claim processing, customer satisfaction, and financial stability. They are expected to work efficiently under pressure, manage multiple tasks simultaneously, and maintain high levels of accuracy and productivity.

Skills & Qualification

• Strong analytical skills, with the ability to review and verify claim details for accuracy and compliance.

• Excellent communication skills, with the ability to effectively collaborate with hospitals, customers, internal teams, and third-party administrators.

• Ability to work efficiently under pressure, manage multiple tasks simultaneously, and maintain high levels of accuracy and productivity.

• Proficiency in insurance claims processing software, with the ability to adapt to new systems and technology.

• Knowledge of medical billing and coding systems, including ICD-10 and CPT.

• Strong problem-solving skills, with the ability to identify and resolve claim-related issues in a timely and efficient manner.

• Ability to maintain accurate records and reports, with a strong attention to detail and organizational skills.

Responsibilities

• End-to-end processing of medical insurance claims (reimbursement), ensuring accuracy, compliance with policy terms, and adherence to turnaround time (TAT).

• Collaborate with hospitals, customers, internal teams, and third-party administrators to deliver timely and efficient claim settlements.

• Review and verify claim details for accuracy and compliance, identifying and resolving any discrepancies or errors.

• Manage multiple claim files simultaneously, prioritizing tasks and meeting deadlines to ensure timely claim settlements.

• Communicate effectively with customers, hospitals, and internal teams to provide timely updates on claim status and resolve any issues or concerns.

• Maintain accurate records and reports, including claim status, payments, and customer interactions.

• Stay up-to-date with changing policy terms, regulations, and industry best practices, applying this knowledge to improve claim processing efficiency and accuracy.

• Participate in quality improvement initiatives, identifying areas for improvement and implementing changes to enhance claim processing efficiency and customer satisfaction.