Medical Claims Examiner Jainco Consulting India Private Limited

About Jainco Consulting India Private Limited

Job Description

Job Title: Medical Claims Processor - Self Funding Specialist Job Description: Jaincotech is seeking a detail-oriented and experienced Medical Claims Processor to support the administration of self-funded health plans. The ideal candidate will possess strong analytical skills and a commitment to delivering excellent service in a fast-paced environment. This role requires expertise in medical coding and proficiency with benefits administration software. Key Responsibilities: Accurately process medical claims in compliance with internal guidelines and regulatory standards. Review and verify claims for accuracy, completeness, and eligibility. Resolve claim discrepancies and coordinate with providers to gather necessary information. Maintain accurate and up-to-date records of processed claims. Collaborate with team members to identify and implement process improvements. Ensure strict confidentiality of patient records and sensitive information. Provide timely and accurate responses to inquiries from providers, members, and internal teams. Qualifications: Minimum of 3 years of experience in self-funded medical claims processing, billing, or examining. Certified Professional Coder (CPC) certification. Proficiency in medical terminology and coding systems (ICD-10, CPT, HCPCS). Hands-on experience with benefits administration software, including VBA, Plexis, or Trizetto. Familiarity with CMS1500 (HCFA) and UB04 forms. Excellent organizational skills and the ability to manage multiple tasks simultaneously. Strong analytical skills and attention to detail. Effective written and verbal communication skills. Ability to work both independently and collaboratively within a team environment. Must Have: CPC (Coding Certification) Experience working in benefits administration software, ideally VBA, PLEXIS, or Trizetto Experience in the following industry segments is required: Self-funded health plans Level-funded health plans Job Type: Full-time Benefits: Health insurance Leave encashment Paid sick time Paid time off Provident Fund Schedule: Fixed shift Monday to Friday Night shift US shift Application Question(s): Which healthcare billing software have you used extensively in your previous roles What is your notice period Education: Bachelor's (Required) Experience: Medical claims processing: 3 years (Required) Language: English (Required) License/Certification: Coding certification (Required) Location: Mumbai Suburban, Maharashtra (Required) Shift availability: Night Shift (Required) Work Location: In person Expected Start Date: 24/03/2025,