Looking immediate joiners only.

Role & responsibilities

- Processes claims in accordance with production, timeliness, and quality standards.
- Participates with other internal departments in the resolution of claims issues across department

lines.
- Ensures claims are processed in compliance with governmental and accrediting agency regulations.
- Ability to read and follow directions
- Ensures the delivery of superior customer services by providing timely and accurate

claims payment and responding timely to member and provider inquiries and complaints regarding claims processing.
- Develops strong intradepartmental relationships with other department personnel and/or

exempt individual contributors to ensure clear communication and prompt resolution to issues.
- Follows departmental policies and procedures regarding claims adjudication.
- Ensures that potential fraudulent claims practices are identified and reported to the
- Follows all HIPAA compliance guidelines to ensure protection of member protected health

information.





Preferred candidate profile

- Understanding of hospital and/or physicians contracts to determine payable advantages and

knowledge of pricing DRG, APC and per diem for all Medical claim products.
- Excellent oral and written communication skills including good grammar, voice, and diction.
- Able to read and interpret documents and calculate figures and amounts.
- Proficient in MS Office with basic computer and keyboarding skills.
- Excellent customer service skills (friendly, courteous, and helpful).
- High school diploma or general education degree (GED) required
- Minimum two years experience in managed care claims processing environment required
- Understanding of configuration of claim processing systems and the links between

contracts, utilization management and claims processing within these systems required
- An equivalent combination of education, training, and experience.

📌 Walk-in || Claim Adjudicator (Pune)
🏢 XBP Global
📍 Pune