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BUSINESS SPECIALIST

Company: HCL Technologies
Location: Santa Clara
Posted on: January 16, 2022

Job Description:

Job FamilyDevelopment (Development) Job Description (Posting).Knowledge & Overall responsibility for the operational and financial efficiency of a claims managementKnowledge of Healthcare domains (Medical, Pharmacy, Claims, Provider, Benefits and Clinical)Knowledge of Medicare/Medicare Advantage processes and Centers for Medicare & Medicaid Services (CMS) guidelines highly preferred.Expertise to provide our clients with the following related services PPO Repricing, Forms Processing, Insurance Fraud Detection, EDI IntegrationKnowledge of Professional PPO claims processing.Experience with healthcare insurance industry, especially BCBS plans. (1.) Co-ordination with On-Site Engineers and attending customer calls (2.) Raising risks, issues and escalation to senior management and customer (3.) To create all quality documents, collect metrics data and conducting Audits. To perform Value creation and KM activities. (4.) To create project plans and keep track of schedule for on time delivery as per the defined quality standards (5.) To ensure process improvement and compliance, and participate in technical design discussion and to review technical documentsQualificationB.Tech No. of Positions1Skill (Primary)Domain Competencies (APPS)-Bus. Process-Insurance-Commercial lines - Claims & Payments Employee GroupBusiness Line FT CitySanta ClaraEntityCSWAuto req ID988407BRExpected Date of Closure06-Jan-2022Location: California Experience: 11-15 Years Country: USA

Keywords: HCL Technologies, Santa Clara , BUSINESS SPECIALIST, Other , Santa Clara, California

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