• Knowledge of medical billing and coding terminologies

• Ready to work in Night Shift as well as Day shift

• Understanding of plan documents and general benefits

• Familiarity with terms such as deductible, out of pocket, coinsurance, and copay

• Strong attention to detail and accuracy

• Ability to work in Microsoft word, Excel

• Process claims and ensure accuracy during testing of plan build

• Understand and analyze plan documents to determine benefits and coverage

• Ability to analyze, review and adjudicate provider claims

• Resolves medical claims by approving or denying documentation; calculates benefit amounts due; initiates payment and/or composes denial letter.

• Ensures the legal compliance of client policies, procedures, and guidelines, as well as legal compliance with state and federal regulations during the claim process.

• Review claims to determine if costs were reasonable and/ or medically necessary.

• Able to identify over-payments, underpayments and other irregularities in Processed claims.

• Verifying member eligibility, benefit coverage and researching or applying authorizations.

• Be able to integrate knowledge as a skilled specialist to solve problems and find new efficient workflows.

• Protects operations by keeping claims information confidential; must be HIPPAA compliant.

• Recognize areas of weakness, provide suggestions, and update documentation for process improvement.

• Perform general and administrative duties as assigned.

Job Type: Full-time

Pay: As per Industry Standards

Schedule:

• Day shift

• Night shift

Experience:

• US Health Insurance: 1 year (Required)

Location:

• Navi Mumbai, Maharashtra (Required)

Shift availability:

• Night Shift (Required)

• Day Shift (Required)

Work Location: In person

We are looking for an experienced EDI Data Specialist to join our team. The ideal candidate will have a solid background in working with EDI (Electronic Data Interchange) data and a deep understanding of various EDI file types.
In this role, you will manage, troubleshoot, and optimize EDI transactions to ensure seamless data exchange between our organization and our partners.

Key Responsibilities:

• Manage and maintain EDI transactions, ensuring accurate and timely data exchange.

• Work with various EDI file types, including X12, EDIFACT, and XML.

• Analyze, design, and implement EDI solutions to meet business needs.

• Collaborate with internal teams and external partners to resolve EDI-related issues.

• Monitor and troubleshoot EDI processes to maintain data integrity and compliance.

• Perform mapping and translation of EDI data between different formats.

• Maintain comprehensive documentation of EDI processes, procedures, and configurations.

• Provide technical support and training to internal users on EDI systems.

• Continuously seek opportunities to enhance and optimize EDI workflows.

Qualifications:

• Strong knowledge of EDI standards and protocols (e.g., X12, EDIFACT).

• Proficiency in mapping and translating EDI files using tools such as [Insert EDI Tool/Software].

• Experience in EDI integration, troubleshooting, and support.

• Excellent analytical and problem-solving skills.

• Strong communication and collaboration abilities.

• Attention to detail and a commitment to data accuracy.

Preferred Qualifications:

Certification in EDI-related technologies is a plus.

Job Types

Full-time, Permanent

Pay: As per Industry Standards

Schedule

• Day shift

Experience

Total work: 1 year (Preferred) Work

Location: Navi Mumbai