Associate II - BPM - Claim Adjudication - Trivandrum

Job Description: Claims Adjudication / Denial Management

Location: Trivandrum, Kerala
Experience: 2–7 Years
Skill: Claim Adjudication / Denial Management

Job Summary

We are looking for professionals with 2–7 years of experience in US Healthcare Claims Adjudication and/or Denial Management. The candidate will be responsible for reviewing healthcare claims, identifying errors or discrepancies, resolving claim denials, and ensuring accurate and timely claim processing.

Key Responsibilities

• Review and adjudicate healthcare claims according to payer policies, client guidelines, and regulatory requirements.
• Analyze denied and rejected claims to identify the root cause of denials.
• Work on denial management, including researching, correcting, and resubmitting claims.
• Verify member eligibility, benefits, coding, billing information, and claim documentation.
• Identify trends and recurring issues contributing to claim denials.
• Coordinate with internal teams such as coding, billing, and AR teams to resolve claim-related issues.
• Maintain accuracy and productivity while meeting defined SLAs and quality targets.
• Document claim decisions, denial reasons, actions taken, and resolution details accurately.
• Ensure compliance with HIPAA and other applicable healthcare regulations.
• Escalate complex or unresolved claims to the appropriate team or supervisor.

Required Skills

• 2–7 years of relevant experience in US Healthcare Claims Adjudication / Denial Management.
• Good understanding of the US healthcare revenue cycle and claims process.
• Knowledge of claim forms such as CMS-1500 and UB-04.
• Understanding of insurance plans, eligibility, benefits, CPT, HCPCS, ICD-10, and modifiers.
• Strong analytical and problem-solving skills.
• Good written and verbal communication skills.
• Ability to analyze denial codes and determine appropriate resolution.
• Good working knowledge of MS Office and healthcare claims-processing systems.

Preferred Skills

• Experience working with US healthcare payers/TPAs.
• Knowledge of denial codes, payer guidelines, and appeals processes.
• Experience with claims adjudication platforms or healthcare RCM tools.
• Ability to handle high-volume claims while maintaining quality and accuracy.

Education

• Any graduate degree is preferred.
• Relevant experience in US Healthcare/RCM/Claims Processing will be considered.

Job Location: Trivandrum, Kerala
Experience: 2–7 Years
Employment Type: Full-time

claims adjudication,healthcare claims,hcpcs coding,claims processing,medical terminology,health plan,policy procedures,

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