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Title:  Health Insurance Claim Processor

Requisition ID:  84180
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

Role Purpose

As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate action to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that all necessary documentation is complete.This is a hybrid in office position located in the Tampa Bay, Fl area. You will be required to be in office for the full duration of the training. After training is completed you will be on a hybrid schedule. You will have to plan accordingly due to being in office 1-2 times a week.

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Responsiblity :

• Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.                                               

• Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.                        

• Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.     

• Data Entry - Enter claim details and maintain accurate records within the claims management system.                                                                              

• Problem resolution - Investigate discrepancies and resolve disputes related claim processing          

• Rework Adjustment Experience - Should be able to perform the rework adjustment basis the provider request and internal rework/adjustment requirement.

 

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Requirements:

  • Working  knowledge of computer System and Programme.
  • Should be able to co-ordinate benefits with Medicare/Medicaid
  • ICD-9 &10 Coding
  • Experience in M&R / Medicaid Rework/Adjustment claims processing preferred.
  • knowledge of Health Care Domain with minimum experience of 3 years in Health care domain and claims processing.
  • Experience in Govt. Ops with a experience of Medicare and Retirement / Medicaid claims processing.
  • Should able to explain the terms, Copay, Coinsurance, Deductible and out of pocket.
  • Should be able to describe Medicaid and Medicare eligibility in detail.
  • Should have experience working as Claim Examiner Level III for minimum 3 years.
  • Should have experience working in Adjustment and Disputes (Appeals) for minimum 2 years.
  • Should have experience working on California Medicaid/Medicare claims.
  • Should be able to understand California claim's contract language.
  • Should have basic knowledge of Corrected claims processing.
  • Should have knowledge of CPT codes and HCPC codes.
  • Should have knowledge of UB04 & CMS1500 form.
  • Should have basic knowledge of Mathematical skills and should be able to problem solve claims calculations. (Benefit/Out of Pocket) . 
 
Mandatory Skills: Claims_Processing .

 

Expected annual pay for this role ranges from $25,000 to $50,000 . 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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