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 strong 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/benefits) 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.
- Valuable
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.
- Strong
analytical and problem-solving skills.
- Good
communication and interpersonal skills.
- Proficiency
in MS Office and claims processing systems.