Claims Representative

The job profile for this position is Claims Representative, which is a Band 1 Professional Career Track Role.

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Job Title: Associate Representative

Role Summary: The CCI representative is responsible for accurate and timely abstraction of claims-related data from various source documents into Salesforce, ensuring compliance with US Healthcare regulations including HIPAA. The role requires a strong understanding of medical claims processing, data integrity, and quality standards.

Job Title

Band 1 High

Business Unit

GHB & GIH

Reports to

Senior Supervisor

Process

Common Claim Intake

Location

Bangalore

Key Responsibilities

• Review incoming claim documents received through multiple intake channels (portals, scanned documents, uploads).
• Accurately capture and validate data from medical claims forms (e.g., CMS-1500, UB-04), Invoices, EOBs, referrals, and supporting documents.
• Review and interpret claims information including:
• Member demographics
• Provider details (NPI, TIN)
• ICD-10, CPT/HCPCS codes
• Modifiers, units, DOS, billed/allowed amounts/currency type
• Ensure compliance with HIPAA and data privacy standards while handling PHI.
• Cross verify entered data against source documents to maintain accuracy and completeness.
• Identify and correct inconsistencies, missing data, or format errors before submitting the form.
• Adhere to documented CCI SOPs, job aids, and common code references.
• Ability to handle complex claim scenarios and meet quality and performance standards.
• Meet daily productivity and quality benchmarks.
• Take a proactive approach to identify and resolve issues.
• Ability to deal with confidential and sensitive matters in a professional manner.
• Have good organizational, multi-tasking, and time management skills, with excellent attention to detail.
• Strong interpersonal skills while dealing with other office staff.
• Excellent written and verbal communication skills.
• Flexible to work in rotational shift.

Required Skills & Qualifications

• Good understanding on US healthcare/Medical claims/Data Capture related to ICD-10, ADA, CPT & HCPCS codes.
• 1 to 2 years experience working with any payer or provider-side claims.
• Strong data entry and document review skills with high attention to detail and accuracy.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Computer proficiency including working knowledge of Microsoft Word and Excel.
• Proficient in typing skills with a speed of 30 words per minute and an accuracy of 95% and above.
• Data accuracy & Integrity focus
• Process adherence & team collaboration

Preferred Qualifications and Educational Qualifications:

• Experience working with payer or provider-side claims.
• Exposure to Appeals & Grievances or Quality audit processes.
• Certification in Medical Coding or Healthcare operations (good to have)
• Any Bachelor's Degree

Performance Metrics

• Productivity (cases per day/hour)
• Quality Accuracy percentage
• Compliance adherence
• Turnaround time (TAT)
• Error rate reduction

Competencies

• Data accuracy & integrity focus
• Confidentiality & compliance mindset
• Process adherence

• Team collaboration
• Continuous improvement orientation

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.