PC01179-HC-Web TPA-Claims Examiner-GGN

PeopleStrong; Gurugram District; On-site; INR 250,000 - 450,000; Full time

Job summary

PeopleStrong in Gurgaon is seeking an Examiner/Sr. Examiner for healthcare claims adjudication, with training responsibilities and client interaction.

The role requires 0-2 years ITES/claims experience, graduate degree, and ability to work in shifts; responsibilities include data entry, reviewing claims, and adherence to processing guidelines including ISO 27001:2013, DPA, HIPAA.

Qualifications

• Graduate or postgraduate in any stream with good academic background.
• 2-3 years of experience in ITES with minimum 1 year in healthcare claims adjudication.
• Typing speed 30-40 WPM (alpha) and 20-30 WPM (numeric).
• Willing to work in shifts and flexible per business needs.

Responsibilities

• Adjudication of US Healthcare claims (Medical, Dental, Hospital, etc.).
• Conduct data entry and re-work by reviewing, researching, investigating, negotiating, processing and adjusting claims.
• Read, review, and analyze claims for complete information and verify eligibility/coverage.
• Determine co-pay, co-insurance and deductible as per plan documents; adjudicate claims.
• Inform supervisor about changes in processing guidelines to maintain accuracy of payments.
• Possibly train new joiners in the process as maturity increases; participate in client calls and organizational activities (ISO 27001:2013, DPA, HIPAA).

Skills

Back Office

Graduate

BA

Education

Bachelor's degree

Postgraduate degree (any)

Job description

Posted On 21 Jul 2026

End Date 04 Aug 2027

Required Experience 0 - 2 years

Basic Details

BAND 5

Grade 10

Designation Associate

Organizational Information

Corporate Entity Sharp Group

Entity Silverskills Pvt Ltd

Business Unit Healthcare Services

Function HC- Web -TPA - Adjudication

Country India

Region North

City Gurgaon M-

Working Location Gurgaon M-

Skills

• Back Office
• Graduate
• BA

Job Description

Designation Examiner/Sr. Examiner

Department - Process Operations - (Adjudication )

Reports to (Designation of the RO) Team Leader

Direct Reports Not Applicable

Key working relationships Will have to closely work with the process supervisor, process trainer and client as there is an initial intense training on claims adjudication. The processing guidelines also changes with the change in policies which has to be closely monitored

Job Description ( describes primary functions of the job ) Job Summary

• Adjudication of Healthcare claims (Medical, Dental, Hospital etc.)
• Imparting trainings to new hires in the process
• Be a part of direct conference calls with client
• Participation in organisational activities

Specific Responsibilities

• Will primarily be responsible for US Healthcare claims adjudication (Medical, Dental, Hospital etc.)
• Conduct data entry and re-work by reviewing, researching, investigating, negotiating, processing and adjusting claims
• Should read, review, and analyze claims for complete information
• Should verify benefit eligibility/membership and coverage type
• Determine appropriate co-pay, co-insurance and deductible information according to plan documents
• Adjudicate claims appropriately after verifing the plan documents thoroughly
• Authorize the appropriate payment or refer claims to investigators for further review
• Should inform process supervisor about any change in processing guidelines so as to maintain accurateness of the claims payment
• Should be a good team player with high on energy as s/he may be required to impart hands on training to the new joinees in the process upon gaining maturity in claims adjudication
• Should have a good hold on Medical Terminologies post class room training as claims for adjudication comes with description in Medical terms
• Consistently meet established productivity, schedule adherence, and quality standards
• Will be required to have conference calls with the clients under supervision
• Should actively participate in organisational activities (viz. ISO 27001:2013, DPA, HIPAA)

Qualification & Experience Essential Skills/ Experience & Qualification :

• The candidate should be a graduate/post graduate in any stream with good academic background.
• Should have 2- 3 years of experience in ITES with minimum of 1 year experience in claims adjudication within a healthcare setting
• Knowledge of contract benefits and claims processing procedures
• Basic knowledge of computer with a typing speed of 30-40 WPM (words per minute) in Alpha keys and 20-30 WPM in numeric keys
• Willing to work in shifts and should be flexible as per the business requirements

Desired Skills/Experience & Qualification:

• People with prior experience in medical billing or US healthcare industry would be preferred
• People from Science stream/Medical Transcription background would have an added advantage