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:
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More than 3 years of experience in handling the Healthcare claims adjudication process.
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Experienced level adjudicator providing analytical ability to review claim rules and workflows.
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Reviews claim requests to determine eligibility for processing and escalate to management as necessary.
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Responsible for the coordination and resolution of the administrative denials and appeals
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Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).
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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.
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Organizing and completing tasks per assigned priorities.
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Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
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Resolving complex situations following pre-established guidelines
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