Assistant Manager – Claims Adjudication

ADVENXA; Ernakulam; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

ADVENXA is seeking a senior professional to lead and manage a team responsible for US healthcare claims adjudication. The role requires coaching, mentoring, and performance management to ensure accurate adjudication per payer guidelines and client requirements.

You will verify member eligibility, review claims, and determine appropriate payments or denials, while handling complex adjustments and escalations in a client-facing environment.

Qualifications

• 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.
• Hands‑on experience with FACETS is preferred.
• 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.

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.

Skills

Team leadership

People management

Stakeholder management

Communication

US healthcare claims lifecycle

Education

Bachelor’s degree

Tools

FACETS

Job description

• 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.
• Hands‑on experience with FACETS is preferred
• 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.