Job Description
Senior Associate – US Healthcare Claims
Location: Kochi Info park, India
Function: Healthcare
Employment Type: Permanent
Reports To: Assistant Manager / Team Manager
Shift : Night Shift
Job Summary
The Senior Associate will be responsible for reviewing and adjudicating US healthcare claims to ensure accurate payment, denial, or development in accordance with provider contracts, benefit plans, coding guidelines, and company policies.
Key Responsibilities
- Review and adjudicate medical claims for accurate coverage, coding, and reimbursement.
- Process professional and institutional claims, including CMS-1500 and UB-04.
- Review provider contracts, fee schedules, and benefit plans to determine appropriate payment.
- Process and analyze Medicare claims, including professional, inpatient, outpatient, ambulance, DRG, and APC claims.
- Apply knowledge of CPT, ICD-10, HCPCS, DRG, APC, and CCI edits.
- Review historical claims and patient/provider information to ensure payment accuracy.
- Identify and resolve claim processing, benefit, system, and fee schedule discrepancies.
- Apply Coordination of Benefits (COB) and Division of Financial Responsibility guidelines.
- Research Medicare fee schedules and coverage determination information as required.
- Maintain accurate claim documentation and comply with HIPAA and regulatory requirements.
- Assist with audits, training, calibration, and process improvement initiatives.
- Meet established quality, productivity, and turnaround-time targets.
- Support team objectives and perform other duties assigned by management.
Required Skills
- Good knowledge of US healthcare claims processing/adjudication and medical terminology.
- Knowledge of CPT, ICD-10, HCPCS, DRG, APC, Medicare, COB, and CCI edits.
- Familiarity with automated claims processing systems.
- Strong analytical and problem-solving skills with excellent attention to detail.
- Good verbal and written communication skills.
- Proficiency in MS Office, especially Excel, Word, PowerPoint, and Outlook.
- Ability to work independently and as part of a team.
Education & Experience
- Bachelor's degree in any field.
- 2 to 4 years of experience in US healthcare claims processing, adjudication, or medical billing preferred.
- Candidates should have a consistent track record of meeting quality and productivity standards.
Key Competencies
Claims Adjudication | US Healthcare | Medicare | Medical Coding | Claims Processing | Quality & Productivity | Analytical Skills | Attention to Detail | Communication
Ability to commute/relocate:
- Kochi, Kerala (Kochi): Reliably commute or planning to relocate before starting work (Required)
Experience:
- Claims: 2 years (Required)
- Facet: 1 year (Required)
Shift availability:
- Night Shift (Required)
- Overnight Shift (Preferred)
Work Location: In person
