Cognet HRO is a leading Business Process Outsourcing Services Company providing full range of HR and F&A services to US based clients ,With over 17 years of rich experience in Payroll Tax, Benefits S & HR Administration, Finance & Accounting , Sales Support. CogNet has been serving the PEO, ASO, HRO and HR Technology spaces since our inception. We help organizations extend their capabilities through simplified implementation, productivity performance measured to the minute, easy collaboration, and transparent pricing built around real time utilization. Our extensive expertise, data library, and workflow development tools accelerates the client implementation process .We have developed a deep expertise of process and technology in our Services , which allows us to rapidly deliver value to our clients. Cognet has been delivering outsourced solutions to the clients around the Globe.
US Healthcare Claims Adjudication – Senior Process Associate
Job Title
Senior Process Associate
Experience Required
4 – 6 Years
Timing
6:30 pm - 3:30 am
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
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Strong knowledge of US healthcare claims adjudication process.
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Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
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Experience in handling commercial, Medicare, and Medicaid claims.
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Knowledge of denials management and appeals processing.
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Familiarity with payer policies and insurance guidelines.
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Strong analytical and problem-solving skills.
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Good communication and interpersonal skills.
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Proficiency in MS Office and claims processing systems.
Eligibility Criteria
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Any Graduate.
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4 – 6 years of relevant experience in US Healthcare Claims Adjudication.
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Experience in handling high-volume claims processing environments preferred.
Preferred Skills
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Experience working with multiple payers and claim platforms.
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Exposure to quality audits and compliance processes.
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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.
