Claims Adjudication Specialist @ Hexaware Technologies

Job Description

Role & responsibilities

• Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication.
• Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial.
• Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information.
• Utilize claims processing systems and software to enter, update, and retrieve claims information accurately.
• Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse.
• Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy.
• Collaborate with team members to improve claims adjudication processes and contribute to departmental goals.
• Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development.

Preferred candidate profile

• 0 to 3 years of experience in healthcare claims adjudication or a related field.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficiency in using claims processing systems and software.
• Ready to work at night shift

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Rs 0 - 50K PM Rs 50K - 1 LPA Rs 1.0 - 1.5 LPA Rs 1.5 - 2.0 LPA Rs 2.0 - 2.5 LPA Rs 2.5 - 3.0 LPA Rs 3.0 - 3.5 LPA Rs 3.5 - 4.0 LPA Rs 4.0 - 4.5 LPA Rs 4.5 - 5.0 LPA Rs 5 - 6 LPA Rs 6 - 7 LPA Rs 7 - 8 LPA Rs 8 - 9 LPA Rs 9 - 10 LPA Rs 10 - 12 LPA Rs 12 - 14 LPA Rs 14 - 16 LPA Rs 16 - 18 LPA Rs 18 - 20 LPA Rs 20 - 22 LPA Rs 22 - 24 LPA Rs 24 - 26 LPA Rs 26 - 28 LPA Rs 28 - 30 LPA Rs 30 - 32 LPA Rs 32 - 34 LPA Rs 34 - 36 LPA Rs 36 - 38 LPA Rs 38 - 40 LPA Rs 40 - 42 LPA Rs 42 - 44 LPA Rs 44 - 46 LPA Rs 46 - 48 LPA Rs 48 - 50 LPA Rs 50 - 75 LPA Rs 75 Lakh - 1C PA Rs 1 Crore+ PA

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Keyskills:   Claims Adjudication Claims US Healthcare Claims Processing