Claims Adjudication

Mdi Networx

1 - 3 years

2 - 5 Lacs

pune

Posted:-1 days ago| Platform:

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Skills Required

us healthcare facets tools claims adjudication insurance claims claim payment claims management claims claims processing

Work Mode

Work from Office

Job Type

Full Time

Job Description

Key Responsibilities:

Adjudicate medical, dental, and vision claims using the
Facets
platform.
Review and analyze claims for eligibility, provider contracts, coding accuracy, and payment rules.
Ensure timely and accurate processing of claims per regulatory and organizational standards (e.g., CMS, HIPAA).
Identify discrepancies or issues in claims data and take corrective actions.
Apply plan benefit designs and provider fee schedules during claim review.
Collaborate with cross-functional teams including customer service, provider relations, and medical management.
Participate in audits and quality checks to ensure process accuracy.
Maintain confidentiality and compliance with data protection standards.

Required Skills & Qualifications:

1 to 3 years
of experience in
healthcare claims adjudication
.
Hands-on experience with Facets
claims processing system is
mandatory
.
Knowledge of CPT, ICD-10, and HCPCS coding standards.
Familiarity with Medicare/Medicaid or commercial insurance claim guidelines.
Strong analytical and problem-solving skills.
Proficient in MS Office applications (Excel, Word, Outlook).
Excellent written and verbal communication skills.
Ability to work independently as well as in a team-oriented environment.

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