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 & Robust 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.
Robust 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 Ambattur
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📍 Ambattur