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 Advantages) 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
- Strong
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 h

📌 Senior Process Associate (Ambattur)
🏢 Cognet Hr Solutions
📍 Ambattur