About Company: Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Company Name: Evolent Health
Job Profile: Claim Adjudicator- Fresher
Work Location: Pune, Maharashtra, India
Degree Required: Any Graduates
Experience Required: Freshers
- Entry level adjudicator providing an introduction to claim rules and workflows
- Responsible for adjudicating claims to maintain/comply with Service Level Agreements
- Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures
- Work high volume of repetitive claims
- Identify claim(s) with inaccurate data or claims that require review by appropriate team members
- Maintain productivity goals, quality standards and aging timeframes
- Contribute positively as a team player
- Complete special projects as assigned
- Comply with all departmental and company Policy and Procedures
Key competencies/skill/success factors:
- Ability to work in a team environment
- Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products
- Attention to detail
- Excellent interpersonal, oral and written communication skills
- Strong attention to detail and organization
- Able to work independently; strong analytic skills
- Strong computer skills
Qualification and Experience:
- Associate or Bachelor degree preferred.
- Experience- Fresher
- Clinical Background and US Healthcare Knowledge.
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