Role 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.
- Strong analytical and problem-solving skills.
- Good written and verbal communication skills.
- Ability to analyze denial codes and determine appropriate resolution.
- Valuable working knowledge of MS Office and healthcare claims-processing systems.

Preferred Skills

- Experience working with US healthcare payers/TPAs.
- Knowledge of denial codes, payer guidelines, and appeals processes.
- Experience with claims adjudication platforms or healthcare RCM tools.
- Ability to handle high-volume claims while maintaining quality and accuracy.

Education
- Any graduate degree is preferred.
- Relevant experience in US Healthcare/RCM/Claims Processing will be considered.

Job Location: Trivandrum, Kerala Experience: 2–7 Years

Employment Type: Full-time

Skills claims adjudication,healthcare claims,hcpcs coding,claims processing,medical terminology,health plan,policy procedures,

📌 Associate II - BPM - Claim Adjudication - Trivandrum (Thiruvananthapuram)
🏢 UST
📍 Thiruvananthapuram