Claims Adjudication Associate

ADVENXA; Ernakulam; On-site; INR 500,000 - 800,000; Full time

Job summary

ADVENXA is seeking a detail-oriented Claims Adjudication Associate with experience in US healthcare claims adjudication. You will review, analyze, and adjudicate claims based on member eligibility, benefits, provider contracts, and payer guidelines.

Experience with FACETS is a strong advantage. The role requires accuracy, analytical problem-solving, and the ability to resolve discrepancies while maintaining thorough documentation.

Qualifications

• Strong understanding of US healthcare insurance and claims lifecycle.
• Knowledge of eligibility, benefits, claims payment, denials, and adjustments.
• Experience with FACETS is a strong advantage.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.

Responsibilities

• Review and adjudicate US healthcare claims accurately and efficiently.
• Verify member eligibility, benefits, coverage, and claim information.
• Analyze claims to determine appropriate payment, denial, or adjustment.
• Review and validate claims against benefit plans, provider contracts, and payer guidelines.
• Identify and resolve claim discrepancies, exceptions, and processing errors.
• Handle claim adjustments, reprocessing, and corrections as required.
• Investigate denied or rejected claims and take appropriate action.
• Maintain accurate documentation of claim decisions and supporting information.

Skills

US Healthcare

Claims Adjudication

FACETS

Analytical Thinking

Attention to Detail

Tools

FACETS software

Job description

FACETS Experience: Preferred / Added Advantage

Shift: 6:00 PM - 3:00 AM

We are looking for a detail-oriented Claims Adjudication Associate with experience in US Healthcare Claims Adjudication. The candidate will be responsible for reviewing, analyzing, and accurately adjudicating healthcare claims based on member eligibility, benefits, provider contracts, and payer guidelines. Hands-on experience with FACETS will be an added advantage.

Responsibilities

• Review and adjudicate US healthcare claims accurately and efficiently.
• Verify member eligibility, benefits, coverage, and claim information.
• Analyze claims to determine appropriate payment, denial, or adjustment.
• Review and validate claims against benefit plans, provider contracts, and payer guidelines.
• Identify and resolve claim discrepancies, exceptions, and processing errors.
• Handle claim adjustments, reprocessing, and corrections as required.
• Investigate denied or rejected claims and take appropriate action.
• Maintain accurate documentation of claim decisions and supporting information.

Requirements

• Strong understanding of US healthcare insurance and claims lifecycle.
• Good knowledge of eligibility, benefits, claims payment, denials, and adjustments.
• Experience with FACETS is a strong advantage.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.