Claims Adjudication

2 days ago


Pune, Maharashtra, India Mdi Networx Full time ₹ 5,50,000 - ₹ 7,50,000 per year

Key Responsibilities:

  • Adjudicate medical, dental, and vision claims using the Facets platform.
  • Review and analyze claims for eligibility, provider contracts, coding accuracy, and payment rules.
  • Ensure timely and accurate processing of claims per regulatory and organizational standards (e.g., CMS, HIPAA).
  • Identify discrepancies or issues in claims data and take corrective actions.
  • Apply plan benefit designs and provider fee schedules during claim review.
  • Collaborate with cross-functional teams including customer service, provider relations, and medical management.
  • Participate in audits and quality checks to ensure process accuracy.
  • Maintain confidentiality and compliance with data protection standards.

Required Skills & Qualifications:

  • 1 to 3 years of experience in healthcare claims adjudication.
  • Hands-on experience with Facets claims processing system is mandatory.
  • Knowledge of CPT, ICD-10, and HCPCS coding standards.
  • Familiarity with Medicare/Medicaid or commercial insurance claim guidelines.
  • Strong analytical and problem-solving skills.
  • Proficient in MS Office applications (Excel, Word, Outlook).
  • Excellent written and verbal communication skills.
  • Ability to work independently as well as in a team-oriented environment.

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