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Title:  Claims Appeal and Grievance Examiner

Requisition ID:  60966
City:  Tampa
Country/Region:  US

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com. 

Job Description

The Claims Adjustment Examiner position responsible for adjusting medical, dental and vision claims.

 

ESSENTIAL JOB FUNCTIONS/DUTIES

  • Coordinate the review and response of member appeals meeting all Department of Labor and client requested guidelines for accuracy, timeliness and documentation
  • Coordinate the review and response to provider disputes meeting all client requested guidelines for accuracy, timeliness and documentation
  • Work with other responsible teams to assist in the research and response to complaints. Teams may be internal or external
  • Follow all HIPAA guidelines for the release of information
  • Coordinate escalations with medical review and follow-up timely to assure timeframes and client expectations are met
  • Interpret Summary Plan Document language
  • Coordinate the hand off to adjustment team when a dispute is over-turned
  • Other duties as assigned

 

QUALIFICATION REQUIREMENTS

  • High School/GED required
  • Demonstrate skills in problem solving and benefit plan interpretation
  • Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus
  • Ability to work independently
  • PC proficiency
  • Average typing ability

 

 

EDUCATION REQUIREMENTS

  • High School Diploma required, Associates degree preferred

 

PHYSICAL REQUIREMENTS

  • Working conditions are normal for an office environment.
  • May be subject to interruptions.
  • Minimal physical exertion.
  • Required to work on a computer.

Expected annual pay for this role ranges from   to . Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options

Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention. Come to Wipro. Realize your ambitions.

Applications from people with disabilities are explicitly welcome.

If you encounter any suspicious mail, advertisements, or persons who offer jobs at Wipro, please email us at helpdesk.recruitment@wipro.com. Do not email your resume to this ID as it is not monitored for resumes and career applications.

Any complaints or concerns regarding unethical/unfair hiring practices should be directed to our Ombuds Group at ombuds.person@wipro.com.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law.

Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity.


Nearest Major Market: Tampa

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