US Healthcare Claims Adjudication – Senior Process Associate

Job Title

Senior Process Associate

Experience Required

4 – 6 Years

Timing

6:30 pm - 3:30 am

Job Summary

We are looking for an experienced US Healthcare Claims Adjudication Specialist with strong knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.

Key Responsibilities

- Perform end-to-end US healthcare claims adjudication.
- Verify member eligibility and benefits based on Date of Service (DOS).
- Apply CPT, ICD-10, HCPCS, and payer adjudication rules accurately.
- Process authorization, corrected, and duplicate claims.
- Handle COB (Coordination of Benefits) and multi-insurance claims processing.
- Review and manage denials, appeals, and claim reprocessing activities.
- Calculate deductibles, copay, coinsurance, and out-of-pocket responsibilities accurately.
- Identify non-covered services, exclusions, accident claims, and policy limitations.
- Ensure compliance with CMS, HIPAA, and payer guidelines.
- Maintain productivity, quality, and turnaround time as per SLA requirements.




- Coordinate with internal teams and stakeholders for issue resolution and escalations.
- Participate in process improvement initiatives and audits.

Required Skills

- Robust knowledge of US healthcare claims adjudication process.
- Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
- Experience in handling commercial, Medicare, and Medicaid claims.
- Knowledge of denials management and appeals processing.
- Familiarity with payer policies and insurance guidelines.
- Strong analytical and problem-solving skills.
- Good communication and interpersonal skills.
- Proficiency in MS Office and claims processing systems.

Eligibility Criteria

- Any Graduate.
- 4 – 6 years of relevant experience in US Healthcare Claims Adjudication.
- Experience in handling high-volume claims processing environments preferred.

Preferred Skills

- Experience working with multiple payers and claim platforms.
- Exposure to quality audits and compliance processes.
- Ability to work independently and manage priorities effectively.

Work Location Ambattur, Chennai

Shift

US day shift / Night Shift

Notice Period

Immediate Joiners or candidates with short notice period preferred.

📌 Senior Process Associate - Claims Adjudicator (Chennai)
🏢 Cognet HR Solutions
📍 Chennai