Reconciliation Officer at Accumed in Chennai(New perungalathur)

About the Role

We are looking for an Associate, Reconciliation to handle rejected and underpaid healthcare claims, investigate the reasons for rejection, and process/resubmit claims accurately to maximize revenue recovery.

Key Responsibilities

• Review and process rejected and underpaid healthcare claims
• Investigate claim rejections and identify the root cause
• Prepare and process resubmissions and appeals within defined timelines
• Ensure claims comply with coding and insurance guidelines
• Review claims from both medical and insurance perspectives
• Identify payment discrepancies and revenue leakage
• Reconcile claims against remittances and processed entries
• Maintain daily production and quality targets
• Identify and report recurring rejection and payment trends
• Provide feedback to Team Leaders on rejection trends and process issues
• Ensure timely follow-up and resolution of outstanding claims
• Report any claim-related issues or observations that may impact the process
• Coordinate with internal and external teams to resolve claim issues
• Maintain proper documentation and professional communication
• Ensure compliance with UAE healthcare regulations, payer guidelines and internal SOPs

Requirements

• 3-5 years of experience in Medical Claims Processing in a UAE provider, payer or TPA environment
• Minimum 2 years of experience in Reconciliation / Resubmission
• Bachelors Degree in Medicine (MBBS) or any medical-related field
• Good knowledge of UAE insurance protocols
• Strong knowledge of HAAD, Riayati and DHA guidelines
• Knowledge of ICD and CPT is preferred
• Strong MS Excel and MS Office skills
• Good analytical and problem-solving abilities
• Ability to handle complex claims and identify appropriate resolutions
• Strong attention to detail and accuracy
• Good communication and coordination skills
• Ability to work independently and meet daily targets