Greetings
Looking for experienced folks from Enrollment and claims, EDI or provider contracting-Member or group enrollment process.
Job Title: Senior manager - Enrollment and claims, EDI or provider contracting& Claims Adjudication (US Healthcare)
Experience: 10+years
Qualification: Bachelors degree
Shift: Night shift
Transportation: Pick up and drop would be provided
Job Summary:
Senior manager - Enrollment and Claims Adjudication will oversee a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, client-specific guidelines, and quality standards. The role ensures efficient workflow, team performance, process improvement, and client satisfaction.
Key Responsibilities:
Team Management & Leadership:
Lead, mentor, and manage a team handling enrollment and claims adjudication processes.
Monitor team productivity, quality, and adherence to service level agreements (SLAs).
Provide training, coaching, and development opportunities to team members.
Conduct regular team meetings,



performance reviews, and provide constructive feedback.
Resolve escalations and complex issues promptly and professionally.
Enrollment Management:
Oversee recent member enrollment, renewals, terminations, and updates in healthcare plans.
Ensure data accuracy for member eligibility, coverage, and benefits.
Collaborate with clients and internal teams to resolve enrollment discrepancies or queries.
Claims Adjudication Oversight:
Supervise the processing of healthcare claims ensuring accuracy and compliance with policies, provider contracts, and regulatory guidelines (HIPAA, CMS, etc.).
Ensure proper review of claims for eligibility, benefits coverage, coding, and payments.
Monitor claim denials and implement corrective action plans to reduce errors and rework.
Process & Compliance:
Ensure compliance with US healthcare regulations, privacy laws (HIPAA), and client-specific guidelines.
Identify process improveme

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