US Healthcare Claims Adjudication – Senior Process Associate
Job Title
Senior Process Associate
Experience Required
4 – 6 Years

Timing
6:30 pm - 3:30 am
Job Summary
We are looking for an experienced US Healthcare Claims Adjudication Specialist with robust knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.
Key Responsibilities

· Review and adjudicate insurance claims (medical/health/advantages) as per policy terms and procedures
· Verify claim details, eligibility, coverage, and supporting documentation
· Identify errors, discrepancies, and missing information; follow up as needed
· Ensure accurate payment, denial, or adjustment of claims within defined SLAs
· Calculate claim payments based on contracts and company rules
· Meet productivity, quality, and turnaround time targets
· Participate in audits, quality reviews, and process improvement initiatives.
· Confirm member eligibility, benefits,



and required documents
· Analyze existing processes and identify areas for optimization and efficiency gains.
· Update claim details and notes correctly in the system

Skills Required
Proficiency in claims processing systems & Strong written and verbal communication skills & Strong knowledge of claims adjudication processes and benefit plans& US health Insurance Knowledge.
Required Skills
Strong knowledge of US healthcare claims adjudication process.
Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
Experience in handling commercial, Medicare, and Medicaid claims.
Knowledge of denials management and appeals processing.
Familiarity with payer policies and insurance guidelines.
Solid analytical and problem-solving skills.
Good communication and interpersonal skills.
Proficiency in MS Office and claims processing systems.
Eligibility Criteria
Any Graduate.
4 – 6 years of relevant experience in US Healt

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