Job Summary:
We are seeking skilled specialists 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.

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 advantages, 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.

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 (India)
🏢 ResultsCX
📍 India