Associate II - BPM - Claim Adjudication - Trivandrum

UST; Thiruvananthapuram; On-site; INR 600,000 - 900,000; Full time

Job summary

UST is seeking professionals with 2-7 years of experience in US healthcare claims adjudication and denial management. The role involves reviewing claims, identifying errors, resolving denials, and ensuring timely processing.

You will work across teams to investigate denials and ensure accurate reimbursements, with emphasis on compliance and thorough documentation. The position requires on-site work in Trivandrum, Kerala, and offers a full-time employment path with opportunities to advance in US

Qualifications

• 2-7 years of experience in US healthcare claims adjudication/denial management.
• Familiarity with CMS-1500 and UB-04 claim forms.
• Understanding of payer guidelines and HIPAA regulations.

Responsibilities

• Review and adjudicate healthcare claims per payer policies and regulations.
• Analyze denials to identify root causes and resolution steps.
• Resubmit corrected claims and verify eligibility and benefits.
• Coordinate with coding, billing, and AR teams to resolve issues.
• Maintain accuracy while meeting SLAs and quality targets.
• Document denial reasons and actions taken for audit trail.

Skills

Experience in US Healthcare Claims Adh

US healthcare revenue cycle

CMS-1500 UB-04 knowledge

Insurance eligibility & CPT/HCPCS/ICD-

Analytical & problem solving

Written & verbal communication

Denial codes & resolution

MS Office & claims processing systems

Education

Graduate degree preferred

US Healthcare/RCM experience

Tools

MS Office

Claims processing systems

Job description

Claims Adjudication / Denial Management

Location: Trivandrum, Kerala
Experience: 2-7 Years
Skill: Claim Adjudication / Denial Management

Job Summary

We are looking for professionals with 2-7 years of experience in US Healthcare Claims Adjudication and/or Denial Management . The candidate will be responsible for reviewing healthcare claims, identifying errors or discrepancies, resolving claim denials, and ensuring accurate and timely claim processing.

Key Responsibilities

• Review and adjudicate healthcare claims according to payer policies, client guidelines, and regulatory requirements.
• Analyze denied and rejected claims to identify the root cause of denials.
• Work on denial management, including researching, correcting, and resubmitting claims.
• Verify member eligibility, benefits, coding, billing information, and claim documentation.
• Identify trends and recurring issues contributing to claim denials.
• Coordinate with internal teams such as coding, billing, and AR teams to resolve claim-related issues.
• Maintain accuracy and productivity while meeting defined SLAs and quality targets.
• Document claim decisions, denial reasons, actions taken, and resolution details accurately.
• Ensure compliance with HIPAA and other applicable healthcare regulations.
• Escalate complex or unresolved claims to the appropriate team or supervisor.

Required Skills

• 2-7 years of relevant experience in US Healthcare Claims Adjudication / Denial Management .
• Good understanding of the US healthcare revenue cycle and claims process.
• Knowledge of claim forms such as CMS-1500 and UB-04 .
• Understanding of insurance plans, eligibility, benefits, CPT, HCPCS, ICD-10, and modifiers.
• Strong analytical and problem-solving skills.
• Good written and verbal communication skills.
• Ability to analyze denial codes and determine appropriate resolution.
• Good working knowledge of MS Office and healthcare claims-processing systems.

Preferred Skills

• Experience working with US healthcare payers/TPAs.
• Knowledge of denial codes, payer guidelines, and appeals processes.
• Experience with claims adjudication platforms or healthcare RCM tools.
• Ability to handle high-volume claims while maintaining quality and accuracy.

Education

• Any graduate degree is preferred.
• Relevant experience in US Healthcare/RCM/Claims Processing will be considered.

Job Location: Trivandrum, Kerala
Experience: 2-7 Years
Employment Type: Full-time