Claims Adjudication Specialist

0 - 5 years

0 - 3 Lacs

Posted:4 days ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

Role & responsibilities

  • Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication.
  • Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial.
  • Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information.
  • Utilize claims processing systems and software to enter, update, and retrieve claims information accurately.
  • Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse.
  • Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy.
  • Collaborate with team members to improve claims adjudication processes and contribute to departmental goals.
  • Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development.

Preferred candidate profile

  • 0 to 3 years of experience in healthcare claims adjudication or a related field.
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Proficiency in using claims processing systems and software.
  • Ready to work at night shift

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Hexaware Technologies

IT Services and IT Consulting

Navi Mumbai Maharashtra

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