- As a Claim Adjudication Manager you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator.

Role

- Supervise claim adjudication staff to ensure claims are processed efficiently and accurately.
- Review complex or escalated claims and make final decisions on approvals or denials.
- Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers).
- Monitor team performance using KPIs (turnaround time, accuracy rate, etc.).
- Collaborate with medical coding, billing, provider relations, and legal teams as needed.
- Handle audits, quality assurance, and process improvement initiatives.
- Open for WFO/ Noida Extension Location/ Night shifts.

Skills: Risk Assessment, Stakeholder Management, Data Analysis, Strategic Planning, Financial Modeling, Project Management

Experience: 10.00-13.00 Years

📌 Manager/ Senior Manager Non RCM (Noida)
🏢 R Systems International
📍 Noida