Job Description
Assistant Manager – Claims Adjudication / Adjustor
Function: Healthcare
Location: Kochi Info Park, India
Employment Type: Permanent
Reports To: Manager / Senior Manager
Shift: Night Shift
Job Summary
The Assistant Manager will be responsible for managing a team of 20–22 associates involved in US Healthcare Claims Adjudication and Adjustments. The role will oversee day-to-day operations, review complex claims and escalations, ensure quality and productivity, and deliver agreed client SLAs and business outcomes.
The ideal candidate should have strong experience in end-to-end US Healthcare Claims Adjudication, Claims Review, or Adjustments, with proven team-handling experience.
Key Responsibilities
- Manage and provide operational support to a team of 20–22 Claims associates.
- Review and resolve complex claims adjustments, escalations, and exceptions.
- Ensure accurate and timely claims adjudication in line with client requirements, policies, contracts, and regulatory guidelines.
- Monitor team performance against quality, productivity, accuracy, and SLA targets.
- Review claims for appropriate coding, coverage, reimbursement, payment, development, or denial.
- Identify and escalate issues related to system configuration, benefits, fee schedules, and adjudication inaccuracies.
- Support processing and review of CMS-1500 and UB-04 claims.
- Provide guidance on CPT, ICD-10, HCPCS, DRG, APC, Medicare, CCI edits, COB, and other claims-related requirements.
- Analyze provider contracts, historical claims, and patient information to ensure payment accuracy.
- Support client queries, escalations, audits, and regulatory requirements.
- Conduct team meetings, calibrations, coaching, feedback, and performance discussions.
- Identify process gaps and drive initiatives to improve workflow, productivity, and quality.
- Support training, cross-training, and knowledge-sharing activities within the team.
- Ensure adherence to HIPAA, company policies, SOPs, and regulatory requirements.
- Promote teamwork and collaboration across internal and external stakeholders.
- Perform other responsibilities assigned by management.
Required Skills
- Strong knowledge of US Healthcare Claims Processing and Adjudication.
- Good understanding of medical terminology, coding, reimbursement, and healthcare insurance processes.
- Working knowledge of CPT, ICD-10, HCPCS, DRG, APC, Medicare, COB, and CCI edits.
- Experience with automated claims processing systems.
- Strong analytical, problem-solving, and decision-making skills.
- Excellent verbal and written communication skills.
- Good knowledge of MS Office, particularly Excel, Word, PowerPoint, and Outlook.
- Strong attention to detail and ability to manage multiple priorities.
- Ability to coach, guide, and manage team performance effectively.
Experience
- 4–6 years of overall experience in US Healthcare Claims Processing, Adjudication, Adjustments, or Medical Billing.
- Minimum 2–3 years of experience as an SME / Team Lead / Assistant Manager or equivalent leadership role.
- Candidates should have demonstrated experience managing high-performing teams and meeting client SLAs, quality, and productivity targets.
Education
- Bachelor's degree with a minimum of 15 years of formal education.
Key Competencies
US Healthcare Claims | Claims Adjudication | Claims Adjustments | Team Management | Escalation Management | Medicare | Medical Coding | Quality Management | SLA Management | Process Improvement | Client Management | Coaching & Development
Ability to commute/relocate:
- Kochi, Kerala (Kochi): Reliably commute or planning to relocate before starting work (Required)
Application Question(s):
- What is the maximum team size you have handled ?
Experience:
- Claims: 4 years (Required)
- Facet Application: 1 year (Required)
Shift availability:
- Night Shift (Required)
- Overnight Shift (Preferred)
Work Location: In person
