Claims Adjudication Process

Role: Claims Adjudication Process

Experience: 2.5-4 Years

Job Location: Coimbatore, Tamil Naidu

Work Timing: US Shift(Night Shift)

Job Description:

Claims Experience is required:

• More than 3 years of experience in handling the Healthcare claims adjudication process.

• Experienced level adjudicator providing analytical ability to review claim rules and workflows.

• Reviews claim requests to determine eligibility for processing and escalate to management as necessary.

• Responsible for the coordination and resolution of the administrative denials and appeals

• Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).

• Ability to resolve claims that require adjustments and adjustment projects , Identify claim(s) with inaccurate data or claims that require review by appropriate team members.

• Organizing and completing tasks per assigned priorities.

• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team

• Resolving complex situations following pre-established guidelines