051037-Claims Associate

About Capgemini


Capgemini is a global leader in consulting, digital transformation, technology and engineering  services. The Group is at the forefront of innovation to address the entire breadth of clients’ opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50-year+ heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations. Capgemini is driven by the conviction that the business value of technology comes from and through people. Today, it is a multicultural company of 270,000 team members in almost 50 countries. With Altran, the Group reported 2019 combined revenues of €17billion.


Visit us at www.capgemini.com. People matter, results count. 


Capgemini is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender identity/expression, age, religion, disability, sexual orientation, genetics, veteran status, marital status or any other characteristic protected by law.

This is a general description of the Duties, Responsibilities and Qualifications required for this position. Physical, mental, sensory or environmental demands may be referenced in an attempt to communicate the manner in which this position traditionally is performed. Whenever necessary to provide individuals with disabilities an equal employment opportunity, Capgemini will consider reasonable accommodations that might involve varying job requirements and/or changing the way this job is performed, provided that such accommodations do not pose an undue hardship.


Click the following link for more information on your rights as an Applicant –http://www.capgemini.com/resources/equal-employment-opportunity-is-the-law

Job Description for Job Title: Claims Associate
oProcessing Cancer claims on daily basis  
oAppeals and Grievances of processed or denied claims
oShould be able to prioritize work and adjudicate claims as per turnaround time
oJob involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment
oShould have strong English and Science knowledge to comprehend Medical reports
oTo ensure claims are adjudicated as per the guidelines of the company. Provide continual evaluation of processes and procedures. 
oTo respond to and resolves claims received via emails.  
oCandidate should be able to correctly calculate claim amounts for the customers
oComplying with company regulations regarding HIPAA, confidentiality, and private health information
oOutbound call making skills for gathering missing information in order to process claims

Skill Set Requirement

oMedical Graduates – MBBS, Physiotherapists, B-Pharma or life science graduates with relevant experience in handling Hospital/ Accident claims
oShould have a minimum of 30 wpm typing speed
oShould have knowledge of Medical terminology, human anatomy with basic math knowledge of calculating simple interest, compound interest.
oShould have good comprehension and analytical skills 
oShould have excellent problem-solving skills
oShould have positive approach and open to learn process dynamics 
oShould have good communication, verbal and written English 
oReady to handle work pressure and ensure deliverables within timelines

Experience for A3/A4
oA3 candidates should have at least 1.5 years of experience in Claims and science graduation background
oA4 candidates should have a minimum of 3 years in claims experience with science graduation background
oShould have in-depth knowledge of ICD 10, CPT, Surgery procedures, Revenue codes
oShould have an experience of reading and comprehending Medical reports
Transcription or Medical underwriting experience will be added advantage

Candidates should be flexible / willing to work across this delivery landscape which includes and not limited to Agile Applications Development, Support and Deployment.



Posted on:

January 8, 2021

Experience level:

Experienced (Non Manager)

Education level:

Bachelor's Degree (±16 years)

Contract type: