About the role
Assistant Manager – Claims Adjudication
Location: Infopark, Kochi
Qualification: Any Degree
Experience: Minimum 5+ Years in Claim adjudication with FACETS experience TL Experience:Minimum 1 Year in Team Handling with strong experience in Attrition and Shrinkage management
Salary: ₹8.5 LPA
Shift: 6:00 PM – 3:00 AM
Responsibilities
- Lead and manage a team handling US healthcare claims adjudication processes.
- Provide effective people management, coaching, mentoring, and performance management to the team.
- Review and adjudicate US healthcare claims accurately in accordance with payer guidelines and client requirements.
- Verify member eligibility, benefits, coverage, provider information, and claim details.
- Analyze claims to determine appropriate payment, denial, adjustment, or reprocessing.
- Handle claim adjustments, corrections, reprocessing, and other complex claim-related issues.
- Investigate denied or rejected claims and ensure appropriate resolution within defined timelines.
- Maintain accurate documentation and ensure adherence to quality and compliance standards.
- Monitor team productivity, quality, SLA adherence, and overall process performance.
- Manage attrition and shrinkage, including tracking trends, identifying root causes, and implementing corrective actions.
Requirements
- Bachelor’s degree or equivalent qualification in any discipline.
- Minimum 5 years of experience in US healthcare claims adjudication, preferably with team-handling/leadership experience.
- Proven experience in team leadership and people management within a healthcare claims/BPO environment.
- Strong understanding of the US healthcare insurance and claims lifecycle.
- Good knowledge of eligibility, benefits, claims processing, payment, denials, adjustments, and reprocessing.
- Demonstrated experience in attrition and shrinkage management.
- Good communication and stakeholder-management skills.
- Ability to handle escalations and work effectively in a client-facing environment.