ABOUT US :
ACKO is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a
customer-first organization serving the digitally-savvy, ACKOʼs value proposition of ʻWelcome Changeʼ focuses on offerings that
make insurance simple and hassle-free! With features such as zero commission, zero paperwork, instant renewal, same-day claim
settlements, and app-based updates on claims, ACKO is a ‘Welcome Change’ from traditional insurers.
Having said that, we are not just another conventional insurance firm, or the people consulted solely for “claims”! Anchored in a
tech-centric philosophy, ACKOʼs approach fuels innovation, empowering us to develop comprehensive products that cater to every
aspect of our customers’ insurance requirements. And while we are at it, we put our Ackers at the heart of everything we do. We’re
not your typical 9-to-5 workplace; we’re a vibrant and inclusive bunch of innovators and creators making sure every Ackerʼs idea
matters, their voice is heard, and their growth is part of our mission.
JOB DESCRIPTION
Job Summary:
We are seeking a detail-oriented and experienced Health Claims Processor to join our team. The ideal candidate will be responsible
for accurately processing and adjudicating medical claims in accordance with company policies, industry regulations, and
contractual agreements. The Health Claims Processor will play a crucial role in ensuring timely processing claims for healthcare
services rendered, maintaining high standards of accuracy and efficiency in claims processing, and providing exceptional customer
service to internal and external stakeholders.
Responsibilities:
- Review and analyze medical claims submitted by healthcare providers for accuracy, completeness, and compliance with
insurance policies and regulatory requirements. - Verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.
- Assign appropriate medical codes (e.g., ICD-10, CPT) to diagnoses, procedures, and services according to industry standards and
guidelines. - Adjudicate claims based on established criteria, including medical necessity, coverage limitations, ensuring fair and accurate
reimbursement. - Process claims promptly and accurately using designated platforms.
- Investigate and resolve discrepancies, coding errors, and claim denials through effective communication with healthcare
providers, insurers, and internal teams. - Collaborate with billing, audit, and other staff to address complex claims issues and ensure proper documentation and
justification for claim adjudication. - Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and
adherence to best practices in claims processing. - Provide courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding
claim status, inquiries, and appeals. - Document all claims processing activities, decisions, and communications accurately and comprehensively in the designated
systems or databases. - Participate in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall
performance.
EXPERTISE AND QUALIFICATIONS
- Bachelor’s degree like, B.A.M.S., B.U.M.S., B.H.M.S., or a related field preferred.
- Minimum of 2-3 years of experience in healthcare claims processing, medical billing, or health insurance administration.
- Proficiency in medical coding systems (e.g., ICD-10, CPT) and claims processing software platforms.
- Strong understanding of healthcare insurance policies, cashless claims methodologies, and regulatory requirements.
- Excellent analytical skills with attention to detail and accuracy in data entry and claims adjudication.
- Effective communication and interpersonal skills with the ability to collaborate across multidisciplinary teams and interact
professionally with external stakeholders. - Demonstrated ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment.
- Problem-solving mindset with the ability to identify issues, propose solutions, and escalate complex problems as needed.
- Commitment to continuous learning and professional development in the field of healthcare claims processing.