Claims Adjudicator – Associate / Sr. Associate

Company Description:-

MDI NetworX is a global leader in business management solutions, supporting health plans, benefit administrators, and healthcare networks across the U.S. We specialize in reducing operational costs, improving adjudication accuracy, and enhancing customer experience through advanced technology and deep domain expertise.

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Role Description:-

We are looking for experienced Claims Adjudication professionals to review and process U.S. healthcare claims with accuracy and compliance. The role involves validating eligibility, benefits, coding accuracy, and ensuring adherence to payer policies and industry regulations.

If you have strong analytical skills, a keen eye for detail, and experience in U.S. healthcare claims processing, we’d love to meet you..!

Key Responsibilities:-

• Review and adjudicate medical claims as per payer policies and agreements.
• Verify eligibility, coverage, and benefits before processing claims.
• Assess CPT, ICD-10, HCPCS codes, and modifiers for accurate reimbursement.
• Identify discrepancies, resolve denials, and ensure compliance with HIPAA & CMS.
• Collaborate with providers, internal teams, and payers for issue resolution.
• Meet accuracy, productivity, and TAT (turnaround time) expectations.

Must-Have Skills:-

• Experience with FACETS tool (mandatory).

• Strong experience in U.S. healthcare claims processing & payer guidelines.
• Knowledge of EOBs, ERAs, and claims adjudication workflows.
• Excellent analytical, communication, and problem-solving skills.
• Strong attention to detail with ability to work in a fast-paced environment.

Educational Qualification:-

• Graduate in any discipline (Healthcare, Commerce, Life Sciences preferred).
• Experience: 1–6 Years in U.S. medical claims adjudication or payer operations.

Shift :- Night Shift

Interested candidates can apply by sharing their updated CV at:

📧 [Rohanb@mdinetworx.com]