Hiring: Claims Adjudication – US Healthcare (Payer End)
We are looking for experienced professionals in US Healthcare Claims Adjudication (Payer Side) to join our team in Hyderabad.
Location: Hyderabad
Experience: 1-15 Year
Work Mode: Work from Office (WFO)
Shift: US Shift
Notice Period: Immediate to 10 Days Only
Key Responsibilities:
- Handle end-to-end US healthcare claims adjudication processes.
- Analyze claim intake, validation, pricing, benefit application, payments, and denials.
- Understand claims processing rules, benefits, eligibility, and reimbursement methodologies.
- Identify claim processing errors, payment discrepancies, and adjudication defects.
- Support root cause analysis and process improvement initiatives.
- Assist with requirement documentation, process mapping, and gap analysis.
- Support test case preparation, User Acceptance Testing (UAT), and defect tracking.
- Coordinate with claims operations and relevant business teams to ensure accuracy and compliance.
Required Skills:
- Hands-on experience in US Healthcare Claims Adjudication – Payer End.
- Good understanding of the US healthcare claims lifecycle.
- Knowledge of medical claims, benefits, eligibility, denials, and payment processes.
- Understanding of ICD-10, CPT, HCPCS, or related coding concepts is preferred.
- Robust analytical, problem-solving, and communication skills.
Important: Candidates must be available to join immediately or within 10 days and be comfortable working from the Hyderabad office in US shifts. Interested candidates can share their updated CV via direct message.