US Healthcare Claims Adjudication

About This Role

This role involves processing and adjudicating US Healthcare claims accurately and efficiently while ensuring compliance with payer and client guidelines. The position is for experienced professionals in US Healthcare Claims Adjudication, working from the office on US shifts.

Responsibilities

• Review and adjudicate US Healthcare medical claims based on defined guidelines
• Validate member, provider, procedure, diagnosis, authorization, and benefit information
• Process claims according to payer policies, contracts, and benefit plans
• Identify and resolve claim errors, discrepancies, and exceptions
• Handle claims involving inpatient, outpatient, professional, and facility services
• Ensure accurate application of deductibles, copayments, coinsurance, and benefit limits
• Identify claims requiring additional information or manual review
• Meet defined quality, productivity, and turnaround-time (TAT) targets
• Follow HIPAA, compliance, and client-specific requirements
• Handle escalations and coordinate with relevant teams for claim resolution
• Handle complex claims and escalations (for SME Roles)
• Support team members with process and claims-related queries (for SME Roles)
• Monitor team performance and ensure productivity and quality targets are achieved (for SME Roles)
• Conduct process briefings and knowledge-sharing sessions (for SME Roles)
• Assist with people management and day-to-day team coordination (for SME Roles)
• Identify process gaps and recommend improvements (for SME Roles)

Requirements

• Any Graduate
• Relevant experience in US Healthcare Claims Adjudication
• Strong hands-on experience in US Healthcare Claims Adjudication is mandatory
• Candidates with hands-on experience in US Healthcare Claims Processing / Claims Adjudication are preferred

Important Details

• Job Locations: Hyderabad, Chennai, Coimbatore
• Work Mode: Work from office
• Shift: US Shifts
• Notice Period: Immediate Joiners Only

Application Process

• Share your resumes