Claims Process Associate

Claims Adjudication Processor role!!!

Chennai

Job Summary:

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.

Qualifications:

• Experience:

  18 to 24 months of experience in claims adjudication, processing, or related healthcare roles.

• Knowledge:

  Strong understanding of healthcare claims processing, including CPT, ICD-10, HCPCS codes, and industry regulations.

• Familiarity with

  government (Medicare/Medicaid), federal, and commercial health plans.

• Analytical Skills:

  Ability to identify and resolve claim discrepancies efficiently.

• Technical Skills:

  Proficiency in claims processing software and Microsoft Office Suite (Excel, Word, Outlook).

• Communication:

  Strong verbal and written communication skills for interacting with internal and external stakeholders.

• Attention to Detail:

  High level of accuracy and ability to manage multiple claims simultaneously.

Preferred Qualifications:

• Experience with claims systems such as Facets, NASCO, Amisys, or similar platforms.
• Knowledge of HIPAA regulations and healthcare compliance requirements.
• Prior experience in a high-volume claims processing environment.