QA - Claims Adjudication

5 - 10 years

3 - 5 Lacs

Posted:8 hours ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

Key Responsibilities:

  • Review and audit healthcare claims for accuracy, completeness, and compliance with payer policies.
  • Identify and resolve discrepancies, errors, and inconsistencies in claims adjudication.
  • Ensure adherence to HIPAA and other regulatory requirements.
  • Work with internal teams to improve claims processing accuracy.
  • Generate reports and document audit findings.
  • Provide feedback and training to claims processing teams.

Required Skills & Qualifications:

  • Bachelor's degree or equivalent experience in healthcare or related fields.
  • Must have: Facet tool experience.
  • Experience in claims adjudication, auditing, or US healthcare payer operations.
  • Strong analytical skills and attention to detail.
  • Knowledge of medical billing, coding, and insurance policies.
  • Proficiency in MS Office and claims processing systems.
  • Effective communication and problem-solving skills.

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