Registered Nurse - Full Time positions

Job Title: Registered Nurse
Job Type: Full Time (Onsite)

In this role, you will be responsible for accurate and timely processing of healthcare claim service requests and processing of claims using your medical knowledge to process according to a workflow that requires the review and evaluation of the service request as per SOP.

Responsible for accurate and timely processing of healthcare claim service request and processing claims

Familiar with Medical Policy, Familiar with Clinical service requests, correspondence inquiries and image review

Prep medical records for clinical review

End to end processing and resolution of clinical claims and correspondence

Understand/interpret medical terminology including clinical notes and reports

Able to review medical policies and determine the appropriate claim processing or clinical review process decisions (pay, request additional records, refer for clinical review)

Review and determine pricing for clinical claims in accordance with negotiated pricing agreements

Adept knowledge of verifying member benefits, eligibility verification and medical necessity determination

To apply clinical judgement in lines of applicable guidelines while they provide post service Medical Necessity Determination (MND) reviews for Claim Policy business area led by reputed US Payer organization/s

To work in collaboration with Medical Directors to deliver top quality medical necessity determination services to clients

High School Diploma or GED Equivalent

Current Puerto Rico Registered Nurse valid license

Intermediate to advanced knowledge in using MS Office and ability to learn and use various computer software

Past experience in an office/clerical setting in the medical field

Experience in any claim adjudication platform

Certification in medical coding (CPT, ICD-10)

Exposure to Healthcare Claims products (Indemnity, PPO, POS/DA, EPO, HMO)

Prior claims experience in medical coding, case management, cost containment review, medical claim management will be preferred

Infosys BPM Limited, a wholly owned subsidiary of Infosys Limited (NYSE: INFY), provides end-to-end transformative business process management (BPM) services for its clients across the globe. The company’s integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients. Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering, automation, and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.

The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others. EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National Origin

Infosys is an equal opportunity employer, and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, spouse of protected veteran, or disability.

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