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Claims Adjudication Mdi Networx

1.0 - 3.0 years

2 - 5 Lacs

pune

Work from Office

Key Responsibilities: Adjudicate medical, dental, and vision claims using the Facets platform. Review and analyze claims for eligibility, provider contracts, coding accuracy, and payment rules. Ensure timely and accurate processing of claims per regulatory and organizational standards (e.g., CMS, HIPAA). Identify discrepancies or issues in claims data and take corrective actions. Apply plan benefit designs and provider fee schedules during claim review. Collaborate with cross-functional teams including customer service, provider relations, and medical management. Participate in audits and quality checks to ensure process accuracy. Maintain confidentiality and compliance with data protection ...

Posted 1 month ago

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