Claim Processor

Evoke HR Solutions Pvt. Ltd.; Chennai, Bengaluru; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Evoke HR Solutions Pvt. Ltd. in Chennai (Hybrid) is seeking an experienced Claims Processor for US healthcare claims, specializing in Facets. The role requires hands-on processing, adjudication, and adherence to client-specific guidelines.

The ideal candidate has extensive experience with US payer/insurance workflows, claims validation, and meeting strict productivity and quality targets. This is a hybrid position with locations across India.

Qualifications

• 35 years of US healthcare claims processing experience.
• Working knowledge of the Facets platform.
• Experience with claims validation and adjudication.

Responsibilities

• Process and adjudicate healthcare claims as per US guidelines.
• Perform claims validation, review, corrections, and resolution of discrepancies.
• Use the Facets system for processing and related activities.
• Ensure accuracy, quality, and compliance with client requirements.
• Meet productivity, turnaround time (TAT), and quality targets.

Skills

US healthcare claims

Facets

Claims adjudication

Payer/insurance domain

Claims validation

Tools

Facets

Job description

Job Title: Claims Processor US Healthcare (Facets)

Experience: 35 Years
Locations: Bangalore / Trivandrum / Chennai
Work Mode: Hybrid

Mandatory Skills:

• US Healthcare Claims Processing
• TriZetto Facets
• Claims Adjudication and Claims Management
• US Healthcare Payer / Insurance Domain
• Claims Validation and Processing

Job Description:

We are looking for an experienced Claims Processor with 35 years of hands-on experience in US healthcare claims processing and working knowledge of the Facets platform.

Key Responsibilities:

• Process and adjudicate healthcare claims as per US healthcare guidelines.
• Work on claims validation, review, corrections, and resolution of discrepancies.
• Use the Facets system for claims processing and related activities.
• Ensure accuracy, quality, and compliance with client requirements.
• Meet productivity, turnaround time (TAT), and quality targets.

Eligibility: Candidates must have relevant US healthcare claims processing experience and Facets skills.