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Job Description: Associate – Claims Adjudication (Appeals & Grievances) Location:OMR Navalur, Chennai, Tamil Nadu Experience:1–3 Years Shift:US Shift (5:00 PM – 2:00 AM IST) Employment Type:Full‑TimeRole Overview: We are looking for a detail‑orientedAssociate – Claims Adjudicationwith hands‑on experience inAppeals and Grievanceswithin US healthcare. The role involves reviewing, analyzing, and resolving appealed and grievance claims in compliance with payer guidelines, regulatory requirements, and internal SLAs.Key Responsibilities: Adjudicateappeals and grievance claimsaccurately and within defined TATs Review medical records, claim history, EOBs, provider correspondence, and payer policies InterpretUS healthcare policies , benefit plans, CPT, ICD‑10, and HCPCS codes Ensure compliance withCMS, HIPAA, and payer‑specific guidelines Identify claim errors, root causes, and recommend corrective actions Document claim decisions clearly and maintain audit‑ready records Meet productivity, quality, and accuracy benchmarks consistently Collaborate with QA, team leads, and downstream teams for issue resolution Escalate complex or high‑risk cases appropriatelyRequired Skills & Qualifications: 1–3 yearsof experience inUS healthcare claims adjudication Mandatory experience inAppeals and Grievances Strong knowledge of: Claims lifecycle and adjudication rules Medical coding (CPT, ICD‑10, HCPCS) Payer policies and benefit interpretation Good analytical and decision‑making skills Strong written and verbal communication skills Comfortable working inUS shifts Proficiency in claims processing systems and MS Office⚠️ Disclaimer:Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels.