Senior Process Associate - Claims Adjudicator

Senior Process Associate - Claims Adjudicator

Job Summary

We are looking for an experienced US Healthcare Claims Adjudication Specialist with strong knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.

Key Responsibilities

• Perform end-to-end US healthcare claims adjudication.
• Verify member eligibility and benefits based on Date of Service (DOS).
• Apply CPT, ICD-10, HCPCS, and payer adjudication rules accurately.
• Process authorization, corrected, and duplicate claims.
• Handle COB (Coordination of Benefits) and multi-insurance claims processing.
• Review and manage denials, appeals, and claim reprocessing activities.
• Calculate deductibles, copay, coinsurance, and out-of-pocket responsibilities accurately.
• Identify non-covered services, exclusions, accident claims, and policy limitations.
• Ensure compliance with CMS, HIPAA, and payer guidelines.
• Maintain productivity, quality, and turnaround time as per SLA requirements.
• Coordinate with internal teams and stakeholders for issue resolution and escalations.
• Participate in process improvement initiatives and audits.

Required Skills

• Strong knowledge of US healthcare claims adjudication process.
• Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
• Experience in handling commercial, Medicare, and Medicaid claims.
• Knowledge of denials management and appeals processing.
• Familiarity with payer policies and insurance guidelines.
• Strong analytical and problem-solving skills.
• Good communication and interpersonal skills.
• Proficiency in MS Office and claims processing systems.

Eligibility Criteria

• Any Graduate.
• 4-6 years of relevant experience in US Healthcare Claims Adjudication.
• Experience in handling high-volume claims processing environments preferred.

Preferred Skills

• Experience working with multiple payers and claim platforms.
• Exposure to quality audits and compliance processes.
• Ability to work independently and manage priorities effectively.

Work Location

Ambattur

Shift

Night shift (6:30 pm - 3:30 am); US day shift / Night Shift

Job Type

Full time

Notice Period

Immediate joiners or candidates with short notice period preferred.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.