Job Summary

This job takes the lead in providing more complex claims adjudication services typically as part of a Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies.Claims Adjudicators provide general support to maintain TAT, meet SLAs, performance and quality levels required by their customers. May mentor less experienced team members.

Essential Responsibilities
Analyzing, validating, updating processing claims, as well as meeting defined scope, targets and SLAs.
Collaborating with customers, business analysts, partners, and IT team members to understand business requirements that drive the innovation and quality. Concentrates on providing cutting-edge solutions to more complex business needs.




Providing required support for new joiners once they gain experience.
Performs work in compliance with all Highmark and Highmark IT standards, policies and procedures.
Effectively communicates with team members, customers, partners and management, including assisting with or conducting more complex walkthroughs, reporting production quality status.
Other duties as assigned or requested.

Experience / Requirements
Greater than 1.5 years of experience in claims adjudication
Bachelors or Masters degree in any discipline
Good verbal and written skills
Positive analytical and interpersonal skills
Valuable to have: AHM or any equivalent certification
Adjustments and Offset/Recovery knowledge

📌 Senior Process Analyst Claims Hyderabad (India)
🏢 enGen Global
📍 India