Associate III
2 weeks ago
Job Title: Claims Adjudication - Non-Voice BPO Process
Experience: 3 to 7 Years
Location: Chennai
Process Type: Non-Voice (Back Office)
Domain: Healthcare / Insurance
Shift: 5.30pm to 2.30pm or 6.30pm to 3.30pm
Job Summary:
We are seeking a detail-oriented and experienced Claims Adjudicator to join our non-voice BPO team. The ideal candidate will be responsible for reviewing, processing, and adjudicating healthcare/insurance claims in accordance with policy guidelines, while ensuring accuracy and compliance with industry standards.
Key Responsibilities:
Review and adjudicate healthcare/insurance claims as per standard operating procedures.
Interpret and validate claim data including member eligibility, provider details, and service coding.
Ensure timely and accurate processing of claims with high attention to detail.
Identify discrepancies or inconsistencies in submitted claims and initiate corrective actions.
Maintain productivity and quality benchmarks as per SLA.
Communicate effectively with internal teams for clarifications and escalations.
Adhere to compliance, confidentiality, and data protection protocols.
Required Skills:
3-7 years of experience in Claims Adjudication within a BPO/Healthcare environment.
Strong understanding of claims processing rules, ICD/CPT codes, and insurance policies.
Hands-on experience with claims adjudication tools and healthcare systems.
Good analytical and problem-solving skills.
Ability to work in a fast-paced and target-driven environment.
Proficiency in MS Office (Excel, Word).
Strong attention to detail and accuracy.
Willingness to work in rotational shifts
Required Skills
Healthcare,Call Center,Call Center Operations,Claims Processing
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