Job Summary

Serve as a claims adjudication specialist within a global healthcare services organization applying robust expertise in MS Excel and medical claims processing for provider and payer domains. Contribute to accurate timely and compliant evaluation of healthcare claims in a hybrid work model with night shifts supporting operational excellence and better health outcomes.

Responsibilities

• Review healthcare claims for provider and payer accounts with careful attention to policy rules eligibility criteria and benefit structures to ensure accurate adjudication and reduce payment errors.
• Analyze claim data in MS Excel using filters lookups pivot tables and structured worksheets to identify discrepancies trends and patterns that support continuous improvement in claim handling.
• Validate key claim elements such as member information provider details coding consistency and billed amounts to help maintain high levels of data integrity and regulatory compliance.




• Apply adjudication guidelines and standard operating procedures consistently across all assigned claims to ensure fair processing outcomes and strengthen trust among healthcare stakeholders.
• Coordinate with internal operations and quality teams to clarify claim related questions and document resolutions that improve process efficiency and reduce repeat issues.
• Maintain detailed and well organized claim tracking logs in spreadsheet templates to monitor status turnaround times and escalations supporting transparent reporting to management.
• Respond to claim inquiries from authorized internal partners in a timely and professional manner providing clear explanations of adjudication decisions that support customer satisfaction.
• Collaborate with colleagues in the hybrid work environment to share best practices in MS Excel usage claim interpretation and payer or provider rules promoting a culture of knowledge sharing.
• Follow defined controls for night shift operations including adherence to cut of

📌 SPE-Claims HC (Pune)
🏢 Cognizant
📍 Pune