Skill required: Claims Appeals - Claims Administration
Designation: Health Admin Services Associate
Qualifications:BCom/Bachelor of Arts/BMM
Years of Experience:1 to 3 years
Language - Ability:English(Domestic) - Intermediate
About Accenture
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
What would you do? The Appeals and Grievance (A&G) Processor is responsible for reviewing, investigating, and resotving member and provider complaints, disputes. and appeals related to healthcare services and coverage decisions. The role ensures compliance with regulatory requirements. timely resolution. and accurate documentation while maintaining high quality and customer satisfaction. Review and process member and provider appeals and grievances in accordance with established guidelines. Investigate cases by gathering and analyzing relevant medical records, claims, and supporting documentation. Ensure all cases are handled within regulatory turnaround times (e.g .. CMS guidelines). Coordinate with internal departments (claims, enrollment billing) and external stakeholders (providers, members). Identify, document, and resolve discrepancies or issues impacting case outcomes. Maintain accurate and complete case documentation in internal systems. Ensure compliance with HIPAA and confidentiality standards when hmdling sensitive information. Communicate decisions clearty to members and providers (written and/or verbal). Track and meet productivity, quality, and service-level targets.
What are we looking for? Health Insurance Operations Healthcare Management Strong attention to detail and analytical skills knowledge of healthcare proces.ses, claims, and insurance policiE S Understanding of regulatory requirements (e.g .. CMS, HIPAA) Excellent written and verbal communication skills Problem-solving and decision-making ability Ability to work independently and manage multiple cases Time management and organizational ski Appeals and Grievance case processing experience
Roles and Responsibilities: •In this role you are required to solve routine problems, largely through precedent and referral to general guidelines • Your expected interactions are within your own team and direct supervisor • You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments • The decisions that you make would impact your own work • You will be an individual contributor as a part of a team, with a predetermined, focused scope of work . Please note that this role requires you to work in US shift time. No rotational or morning shifts
BCom,Bachelor of Arts,BMM
