Claims Examiner I - BPA

Smart Data Solutions; Chennai; On-site; INR 300,000 - 500,000; Full time

Job summary

A technology solutions provider in Chennai is looking for a Claims Examiner I to review and process healthcare claims. This entry-level position requires attention to detail, effective communication, and a high school diploma. Candidates should have 1-2 years of claims processing experience and a willingness to learn. The role offers full-time work hours from 4:00 PM to 1:00 AM.

Qualifications

• 1-2 years of healthcare claims processing or related experience.
• Familiarity with claim forms and basic medical terminology.
• Ability to navigate multiple systems efficiently.

Responsibilities

• Review and process healthcare claims using SOPs and benefit plans.
• Apply basic coding and reimbursement rules.
• Document claim decisions clearly in the system.

Skills

Attention to detail

Effective communication

Ability to prioritize

Education

High school diploma or equivalent

Tools

Javelina

WLT

VBA

Job description

Join to apply for the Claims Examiner I - BPA role at Smart Data Solutions

Job Title: Claims Examiner I

About Us

For over 20 years, Smart Data Solutions has partnered with leading payer organizations to provide automation and technology solutions that enable data standardization and workflow automation. The company offers comprehensive services to handle all claims and claims-related information, regardless of format (paper, fax, electronic), digitizing and normalizing for seamless use by payer clients. Our solutions include intelligent data capture, conversion, digitization, mailroom management, clearinghouse services, and proprietary workflow offerings. SDS is headquartered just outside of St. Paul, MN, leveraging dedicated onshore and offshore resources. We serve over 420 healthcare organizations, including Blue Cross Blue Shield state plans, regional health plans, and independent TPAs, handling over 500 million transactions annually with a 98%+ customer retention rate. We have invested in automation and machine learning to enhance scalability, efficiency, and client results.

Location: 6th Floor, Block 4A, Millenia Business Park, Phase II MGR Salai, Kandanchavadi, Perungudi, Chennai- 600096

Smart Data Solutions is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other protected statuses. Due to access to Protected Healthcare Information, employees in this role must be free of felony convictions.

Summary

The Claims Examiner I is responsible for accurately reviewing and processing routine medical, dental, and vision claims according to established guidelines, benefit policies, and regulatory standards. This entry-level role is suitable for individuals seeking growth in healthcare claims. Under supervision, the Claims Examiner I learns claims adjudication procedures, applies coding and fee schedule rules, and supports claims processing accuracy and timeliness.

Responsibilities

• Review and process healthcare claims (e.g., CMS-1500, UB-04, ADA) using SOPs, benefit plans, and claim system edits.
• Apply basic coding (ICD-10, CPT, HCPCS, modifiers) and reimbursement rules.
• Verify member eligibility, benefits, and provider information.
• Adhere to production and quality standards within turnaround times.
• Respond professionally to inquiries, emails, or audit items.
• Document claim decisions clearly in the system.
• Participate in training and quality assurance activities.
• Maintain knowledge of workflows, policies, and procedures.
• Support process improvements and peer reviews.
• Ensure compliance with data privacy standards (HIPAA).
• Participate in meetings and continuing education.
• Escalate complex claims for guidance.

Qualifications

• High school diploma or equivalent
• 1-2 years of healthcare claims processing or related experience
• Familiarity with claim forms and basic medical terminology
• Ability to navigate multiple systems efficiently
• Attention to detail and accuracy
• Effective communication skills
• Ability to prioritize and meet deadlines
• Independent working ability and adaptability
• Willingness to learn and grow within the team

Preferred Candidates Possess

• Experience with claims systems (e.g., Javelina, WLT, VBA)
• Knowledge of ICD-10, CPT, HCPCS coding
• Understanding of insurance concepts (deductibles, copays, coinsurance, COB)
• Experience with Health Plans or TPAs
• Knowledge of Medicare, Medicaid, or other government programs

Work hours: 4:00 PM to 1:00 AM

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Finance and Sales

Industries

• IT Services and IT Consulting