Claims Representative

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

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.