US Healthcare Claims Adjudication & Provider Directory Specialist

About the Role:

We are looking for experienced professionals with expertise in Claims Adjudication and Provider Directory Management within the US Healthcare domain. The ideal candidate will have hands-on experience handling healthcare claims, validating provider data, and ensuring compliance with payer policies and CMS regulations.

Key Responsbilities

• Review, process, and

  adjudicate healthcare claims

  (professional & institutional) accurately.
• Analyze claims for

  eligibility, coding accuracy, and payer policy compliance

  .
• Identify and resolve claim discrepancies, denials, and adjustments.
• Maintain and update

  provider directory information

  —including provider demographics, specialties, and credentialing details.
• Ensure provider data accuracy across internal systems and payer portals.
• Collaborate with cross-functional teams (billing, coding, network ops) for issue resolution.
• Meet defined productivity, accuracy, and turnaround time (TAT) metrics.

Requirements:

• 2–5 years of experience

  in

  US Healthcare Claims Adjudication

  and/or

  Provider Data Management

  .
• Strong understanding of

  RCM workflows

  ,

  HIPAA compliance

  , and

  CMS guidelines

  .
• Excellent attention to detail, communication, and analytical skills.
• Willingness to work in

  US shifts

  (if required)

Why Join Us :

• Competitive salary and incentive structure.
• Opportunity to work with top US healthcare clients.
• Supportive, growth-oriented, and collaborative work culture.
• Skill development and certification assistance.