Job Description
Nurse Consultant - NCLEX RN Industry: BPO (Healthcare) Location: Infopark, Kakkanad, Kochi Qualification: BSC Nursing/ Post BSC (GNM not considered) Requirement: Valid NCLEX-RN Certification(Manadatory) Shift: 6PM to 3AM (Monday-Friday) Salary: 40,000/- to 60,000/- (CTC) Per Month Should have excellent fluency in English. Responsibilities Review and analyze medical claims, provider appeals, and dispute cases within the US healthcare insurance process. Evaluate clinical documentation, medical records, and supporting evidence to determine medical necessity and appropriateness of care. Assess healthcare claims using clinical guidelines, payer policies, and utilization management criteria. Process appeals, grievances, pre-authorizations, and utilization review cases accurately and within defined timelines. Collaborate with physicians, healthcare providers, and internal teams to gather and review additional clinical information. Ensure compliance with US healthcare regulations, insurance po...