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
· Review and adjudicate insurance claims (medical/health/benefits) as per policy terms and procedures
· Verify claim details, eligibility, coverage, and supporting documentation
· Identify errors, discrepancies, and missing information; follow up as needed
· Ensure accurate payment, denial, or adjustment of claims within defined SLAs
· Calculate claim payments based on contracts and company rules
· Meet productivity, quality, and turnaround time targets
· Participate in audits, quality reviews, and process improvement initiatives.
· Confirm member eligibility, benefits, and required documents
· Analyze existing processes and identify areas for optimization and efficiency gains.
· Update claim details and notes correctly in the system
Skills Required
Proficiency in claims processing systems & Strong written and verbal communication skills & Robust knowledge of claims adjudication processes and benefit plans& US health Insurance Knowledge.
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 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.