Claims Adjudication Specialist

Hexaware Technologies

0 - 5 years

0 - 3 Lacs

Mumbai Navi Mumbai

Posted:6 days ago| Platform:

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Skills Required

Claims Adjudication Claims US Healthcare Claims Processing

Work Mode

Work from Office

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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