JOB Description : Claims Processor
Summary:
Process healthcare claims and determine the amount of healthcare benefits to be paid to the providers for the given portfolio.
Tasks:
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Process and adjudicate the claims as per the Table of Benefit of the member
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Check eligibility of the insured and dependents
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Check premium status where necessary
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Check claims as per policy requirements
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Check provider’s page for bank details and correct Provider -code to use
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Forward payment notices to Claims Supervisor for validation
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Check provider agreed tariffs in case of direct billing claims
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Capture the medical services with the adequate codes (ICD 10 – CPT)
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Process correct healthcare claims and prior approval agreements within deadlines and as per contract provisions
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Forward high cost amount claims to the medical team for evaluation
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Detect any case of abuse or fraud
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Claims audit targets are being met
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Ensure daily productivity targets are met as set by management
QUALIFICATIONS
Experience:
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Optional Experience: Previous experience in medical insurance
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Experience with ICD-10 and CPT medical coding
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English a must (German/french good to have)
Company Information
At ContactPoint360, we are relentlessly focused on delivering exceptional customer experiences. As the fastest-growing BPO on the planet, with over 5,000 teammates across 10 global locations, we combine cutting-edge technology with innovative strategies to help our clients succeed. Our approach is simple: obsess over customers, think long-term, and build a team of smart, driven professionals who thrive in a high-growth, high-impact environment. We’re not just a service provider—we’re a partner in driving real results. ContactPoint360 is where innovation, execution, and customer obsession meet.
We are one of the fastest-growing BPOs in the world, and our secret is simple: it’s our people. We invest in our people and develop them into future leaders. Did you know 50% of ContactPoint360’s leaders were promoted from within? Our CEO’s journey, starting as a phone agent, reflects our commitment to genuine care for our people—it’s in our DNA.
Join the #ChangeMakers movement at ContactPoint360, where your creativity and passion aren’t just welcomed—they’re essential.
Our Purpose:
Our goal is to create the best human experience, ensure the highest client satisfaction, and transform clients’ customers into loyal advocates for life.
Check out our YouTube video: https://youtu.be/AsPjX-5uyQQ
