Job Summary

We are seeking skilled professionals for the US Healthcare Claims Adjudication – Voice Process role. The candidate will be responsible for handling inbound/outbound calls related to medical claims, ensuring accurate adjudication support, resolving provider/member queries, and maintaining compliance with US healthcare regulations.

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Key Responsibilities

- Handle inbound and outbound calls with providers, payers, and members regarding claims status and adjudication.
- Review, analyse, and assist in adjudication of medical claims based on policy guidelines.
- Explain claim denials, payment details, and EOBs (Explanation of Advantages) clearly to stakeholders.
- Resolve customer queries related to benefits, eligibility, claim processing, and reimbursement.




- Ensure compliance with HIPAA guidelines and US healthcare regulations.
- Document interactions accurately in the system and update claim records.
- Coordinate with internal teams (non-voice/back-end) for claim resolution and escalations.
- Identify process gaps and suggest improvements to enhance service quality.
- Meet defined quality, productivity, and SLA metrics.

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Required Skills & Qualifications:

Education

- Any Graduate (preferably Life Sciences, Pharmacy, Nursing, or related field)

Experience

- 1–5 years in US Healthcare (Claims Adjudication / Voice Process)
- Prior experience in payer or provider domain

📌 Claims entry level voice process (Bengaluru)
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