Cliams Adjudication

**Must Have - Cliams Adjudication**

**Exp - 1 + years 4 + years**

**Location - Chennai**

**Notice - Immediate
**Skills Expectation**:

- Experienced level adjudicator providing analytical ability to review claim rules and workflows.
- Reviews claim requests to determine eligibility for processing and escalate to management as necessary.
- Responsible for the coordination and resolution of the administrative denials and appeals
- Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).
- Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
- Organizing and completing tasks per assigned priorities.
- Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
- Resolving complex situations following pre-established guidelines

**Requirements for this role include**:

- University degree or equivalent that required formal studies of the English language and basic Math
- Strong experience processing claims for the US healthcare market
- Knowledge of HRP - added advantage.
- Strong experience of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.