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/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.
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.
Robust
analytical and problem-solving skills.
Good
communication and interpersonal skills.
Proficiency
in MS Office and claims processing systems.

Eligibility Criteria
Any
Graduate.
4 – 6
yea

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🏢 Cognet Hr Solutions
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