Claims Adjudicator

**Job Information**:
Job Opening ID

**ZR_51_JOB**

Number of Positions

**2**

Job Opening Status

**In-progress**

Date Opened

**02/20/2025**

Industry

**BPO**

Job Type

**Full time**

**Required Skills**:

- Eye for detail
- Good in US Claims process...

+1

Work Experience

**4-5 years**

Shift Type

**Night**

City

**Ambattur**

State/Province

**Tamil Nadu**

Country

**India**

Zip/Postal Code

**600053**

**About Us**:
**Cognet HRO**is a leading Business Process Outsourcing Services Company providing full range of **HR and F&A**services to** US based clients ,**With over 17 years of rich experience in **Payroll Tax, Benefits S & HR Administration, Finance & Accounting, Sales Support**. **CogNet**has been serving the PEO, ASO, HRO and HR Technology spaces since our inception. We help organizations extend their capabilities through simplified implementation, productivity performance measured to the minute, easy collaboration, and transparent pricing built around real time utilization. Our extensive expertise, data library, and workflow development tools accelerates the client implementation process.We have developed a deep expertise of process and technology in our Services, which allows us to rapidly deliver value to our clients. **Cognet** has been delivering outsourced solutions to the clients around the Globe.

**Key Responsibilities**:

- Review, verify, and adjudicate claims from the insurance side, ensuring all required documentation and information are accurate and complete.
- Conduct thorough analysis to determine claim eligibility, coverage, and payment amounts in accordance with policies and guidelines.
- Final approval of claims, ensuring that all decisions are accurate, fair, and consistent with established insurance protocols.
- Communicate effectively with claimants, healthcare providers, or other relevant parties to gather additional information or clarify discrepancies.
- Ensure that all claims are processed and approved within established timelines, maintaining high-quality standards.
- Identify and resolve any issues or discrepancies in claims during the verification process.
- Maintain detailed records of claim approvals, denials, and communications, adhering to confidentiality and regulatory requirements.
- Work closely with other teams and departments to resolve complex claims and ensure smooth claims processing.
- Stay up-to-date with changes in insurance policies, regulations, and industry standards to ensure compliance in all claims decisions.
- Provide guidance and mentorship to junior team members regarding claims adjudication processes.

**Required Skills & Qualifications**:

- 2-5 years of experience in claims adjudication, insurance, or a related field, with significant experience in approving claims from the insurance side.
- Strong understanding of insurance claims policies, processes, and procedures, including final approval authority.
- Excellent communication skills, both written and verbal, with the ability to clearly explain claims decisions to claimants and other stakeholders.
- Exceptional attention to detail, ensuring accurate review and approval of claims.
- Ability to effectively analyze, verify, and validate claims data and documentation.
- Strong problem-solving skills and ability to identify and address discrepancies or issues in claims.
- Proficiency in using claims management systems and software.
- Ability to work independently, meet deadlines, and maintain high standards of quality in a fast-paced environment.

**Preferred Qualifications**:

- Experience in health insurance, workers' compensation, or other types of claims processing.
- Familiarity with regulatory and legal requirements related to claims adjudication.
- Certification or coursework in claims management, insurance, or related fields is a plus.