Senior Process Associate

US Healthcare Claims Adjudication – Senior Process Associate

Job Title

Senior Process Associate

Experience Required

Job Summary

We are looking for an experienced US Healthcare Claims Adjudication Specialist with strong knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.

Key Responsibilities

·        Review and adjudicate insurance claims (medical/health/benefits) as per policy terms and procedures

·        Verify claim details, eligibility, coverage, and supporting documentation

·        Identify errors, discrepancies, and missing information; follow up as needed

·        Ensure accurate payment, denial, or adjustment of claims within defined SLAs

·        Calculate claim payments based on contracts and company rules

·        Meet productivity, quality, and turnaround time targets

·        Participate in audits, quality reviews, and process improvement initiatives.

·        Confirm member eligibility, benefits, and required documents

·        Analyze existing processes and identify areas for optimization and efficiency gains.

·        Update claim details and notes correctly in the system

 Skills Required
Proficiency in claims processing systems & Strong written and verbal communication skills & Strong knowledge of claims adjudication processes and benefit plans&  US health Insurance Knowledge.

Required Skills

• Strong knowledge of US healthcare claims adjudication process.
  
• Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
  
• Experience in handling commercial, Medicare, and Medicaid claims.
  
• Knowledge of denials management and appeals processing.
  
• Familiarity with payer policies and insurance guidelines.
  
• Strong analytical and problem-solving skills.
  
• Good communication and interpersonal skills.
  
• Proficiency in MS Office and claims processing systems.
  

Eligibility Criteria

• Any Graduate.
  
• 4 – 6 years of relevant experience in US Healthcare Claims Adjudication.
  
• Experience in handling high-volume claims processing environments preferred.
  

Preferred Skills

• Experience working with multiple payers and claim platforms.
  
• Exposure to quality audits and compliance processes.
  
• Ability to work independently and manage priorities effectively.
  

Work Location

Ambattur, Chennai

Shift

US day shift / Night Shift

Notice Period

Immediate Joiners or candidates with short notice period preferred.