Job Title: Claims Adjudication ProcessorJob Summary: We are seeking a detail-oriented and analytical Claims Adjudication Processor to join our team. The ideal candidate will be responsible for reviewing, processing, and resolving pending healthcare claims while ensuring compliance with federal, government, and commercial health plan policies. This role requires a strong understanding of medical claims processing, payer regulations, and industry guidelines.Job Location-ChennaiInterested can please share CV on babeeta.shahi@Key Responsibilities:· Process and adjudicate healthcare claims efficiently and accurately, ensuring compliance with company policies and industry standards.· Investigate and resolve pended claims by reviewing documentation, identifying discrepancies, and taking necessary actions.· Interpret and apply policies related to government (Medicare/Medicaid), federal, and commercial health plans.· Research and analyze claims issues, including coding errors, missing information, and policy limitations, to determine appropriate resolutions.· Work with internal teams, providers, and payers to ensure timely claim resolution.· Maintain and update claims processing systems with accurate information.· Ensure claims meet regulatory, contractual, and compliance requirements.· Identify trends and escalate issues to management as needed.· Meet quality and productivity standards set by the organization.
Job Title
Claims Adjudicator