Position: Claims - TL-TM-SME
Location: Kochi / Pune
Night Shift - WFO
Healthcare Operations leader with 6+ years of experience in U.S. payer-side healthcare operations across Medicare, Medicaid, Commercial, business, Claims Adjudication, Clean Claims Processing
Responsible for keying,processing and/or adjusting healthclaims inaccordance with claims policies and procedures
Good understanding of the application of benefit contracts, pricing , processing,policies procedures, govt regs, coordination of perks, & amp; healthcare terminology.
Monitor team performance metrics including [AHT, claim resolution rate, patient satisfaction]. Coach, mentor, and develop staff through regular training and performance evaluations. Collaborate with clinical and operational teams to ensure alignment with healthcare regulations (e.g., HIPAA, Claims adjudication, Case Management).
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📌 Claims Specialist (India)
🏢 Aptita
📍 India