Assistant Manager Claims Adjudication

Advenxa Recruitment; Ernakulam; On-site; INR 1,000,000 - 1,200,000; Full time

Job summary

Advenxa Recruitment is seeking an Assistant Manager – Claims Adjudication to lead a team handling US healthcare claims adjudication from Infopark, Kochi. The role requires a minimum of 5 years of claims experience and leadership capabilities.

The candidate will ensure accurate adjudication, adherence to payer guidelines, and effective stakeholder management in a client-facing setting while driving quality and performance metrics.

Qualifications

• Bachelor’s degree or equivalent in any discipline.
• Minimum 5+ years in US healthcare claims adjudication, with leadership experience preferred.

Responsibilities

• Lead and manage a team handling US healthcare claims adjudication processes.
• Provide people management, coaching, mentoring, and performance management to the team.
• Review and adjudicate US healthcare claims according to payer guidelines and client requirements.
• Verify member eligibility, benefits, coverage, provider information, and claim details.
• Analyze claims to determine payment, denial, adjustment, or reprocessing.
• Handle claim adjustments, reprocessing, and complex claim-related issues.
• Investigate denied or rejected claims and resolve within defined timelines.
• Maintain documentation and ensure quality and compliance standards.
• Monitor team productivity, quality, SLA adherence, and process performance.
• Manage attrition and shrinkage, identify root causes, implement corrective actions.

Skills

Team leadership

People management

Communication skills

Stakeholder management

Client-facing experience

US healthcare domain knowledge

Education

Any degree

Tools

FACETS

Job description

Job Description:

Assistant Manager – Claims Adjudication

Location: Infopark, Kochi

Qualification: Any Degree

Experience: Minimum 5+ Years

Salary: ₹10 LPA

Shift: 6:00 PM – 3:00 AM

FACETS Experience: Preferred

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.
• 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.

Requirements: