Role Description

Job Description: Claims Adjudication / Denial Management

Location: Trivandrum, Kerala

Experience: 2–7 Years

Skill: Claim Adjudication / Denial Management

Job Summary

We are looking for professionals with 2–7 years of experience in US Healthcare Claims Adjudication and/or Denial Management. The candidate will be responsible for reviewing healthcare claims, identifying errors or discrepancies, resolving claim denials, and ensuring accurate and timely claim processing.

Key Responsibilities

Review and adjudicate healthcare claims according to payer policies, client guidelines, and regulatory requirements.
Analyze denied and rejected claims to identify the root cause of denials.
Work on denial management, including researching, correcting, and resubmitting claims.
Verify member eligibility, benefits, coding, billing information, and claim documentation.
Identify trends and recurring issues contributing to claim denials.
Coordinate with internal teams such as coding, billing, and AR teams to resolve claim-related issues.




Maintain accuracy and productivity while meeting defined SLAs and quality targets.
Document claim decisions, denial reasons, actions taken, and resolution details accurately.
Ensure compliance with HIPAA and other applicable healthcare regulations.
Escalate complex or unresolved claims to the appropriate team or supervisor.

Required Skills

2–7 years of relevant experience in US Healthcare Claims Adjudication / Denial Management.
Good understanding of the US healthcare revenue cycle and claims process.
Knowledge of claim forms such as CMS-1500 and UB-04.
Understanding of insurance plans, eligibility, benefits, CPT, HCPCS, ICD-10, and modifiers.
Robust analytical and problem-solving skills.
Good written and verbal communication skills.
Ability to analyze denial codes and determine appropriate resolution.
Good working knowledge of MS Office and healthcare claims-processing systems.

Preferred Skills

Experience working with US heal

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