07 Sep
|
R Systems International
|
Noida
07 Sep
R Systems International
Noida
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.
📌 Manager/ Senior Manager Non Rcm Noida
🏢 R Systems International
📍 Noida