Were Hiring | US Healthcare Claims Adjudication

Exciting opportunities for experienced professionals in US Healthcare Claims Adjudication across multiple locations!

- Mandatory Skill: US Healthcare Claims Adjudication
- Job Locations: Hyderabad | Chennai | Coimbatore
- Work Mode: Work from office
- Shift: US Shifts

Experience & Compensation SPE: 1.64 years 4.5 LPA

SME: 4.56 years 6.44 LPA

Role Claims Adjudication The candidate will be responsible for processing and adjudicating US Healthcare claims accurately and efficiently while ensuring compliance with payer/client guidelines.

Key Responsibilities:

- Review and adjudicate US Healthcare medical claims based on defined guidelines.
- Validate member, provider, procedure, diagnosis, authorization, and benefit information.
- Process claims according to payer policies, contracts, and benefit plans.
- Identify and resolve claim errors, discrepancies, and exceptions.
- Handle claims involving inpatient, outpatient, professional, and facility services.
- Ensure accurate application of deductibles, copayments, coinsurance, and benefit limits.
- Identify claims requiring additional information or manual review.
- Meet defined quality,



productivity, and turnaround-time (TAT) targets.
- Follow HIPAA, compliance, and client-specific requirements.
- Handle escalations and coordinate with relevant teams for claim resolution.

For SME Roles

- Handle complex claims and escalations.
- Support team members with process and claims-related queries.
- Monitor team performance and ensure productivity and quality targets are achieved.
- Conduct process briefings and knowledge-sharing sessions.
- Assist with people management and day-to-day team coordination.
- Identify process gaps and recommend improvements.

Eligibility

- Qualification: Any Graduate
- Experience: Relevant experience in US Healthcare Claims Adjudication
- Notice Period: Immediate Joiners Only
- Candidates with hands-on experience in US Healthcare Claims Processing / Claims Adjudication are preferred.

Key Requirement Solid hands-on experience in US Healthcare Claims Adjudication is mandatory.

Interested candidates can DM or share their resumes:

[email protected]

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📌 US Healthcare (Hyderabad)
🏢 Career Guideline
📍 Hyderabad