Process Analyst Claims Adjudication

enGen Global; Chennai; On-site; INR 420,000 - 620,000; Full time

Job summary

enGen Global in Chennai seeks a Process Analyst/Senior Process Analyst to lead complex claims adjudication within an Operations team. You will analyze, validate, update and adjudicate claims to meet Highmark standards and policies, mentor newer teammates, and ensure timely turnarounds.

Experience required is more than 1.5 years; a Bachelor's or Master's degree is required. The role involves a rotational shift, and Immediate Joiners are preferred. Training and growth opportunities are available.

Qualifications

• More than 1.5 years of claims adjudication experience.
• Bachelor's or Master's degree in any discipline.
• AHM certification or equivalent preferred.
• Knowledge of adjustments and offset/recovery

Responsibilities

• Analyzing, validating, updating processing claims, meeting defined scope, targets and SLAs.
• Collaborating with customers, business analysts, partners, and IT to understand requirements driving innovation and quality.
• Providing support for new joiners as they gain experience.
• Complying with Highmark and IT standards, policies and procedures.
• Communicating with team, customers, partners and management, including walkthroughs and status reporting.
• Other duties as assigned or requested.

Skills

Verbal communication

Written communication

Analytical thinking

Interpersonal skills

Education

Bachelor's or Master's degree

Job description

Job Summary

This job takes the lead in providing more complex claims adjudication services typically as part of a Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies .Claims Adjudicators provide general support to maintain TAT, meet SLAs, performance and quality levels required by their customers. May mentor less experienced team members.

Experience

1-4 Years

Shift

Rotational

Designation

Process Analyst/ Senior Process Analyst

Location

Chennai, Tharamani

Notice Period

Immediate Joiners

Interview Process

Technical Round 1

Technical Round 2

HR Round

Communication Round (Versant)

HR Details

Contact HR: Akhila B

Contact Number: 7702422664

Essential Responsibilities

• Analyzing, validating, updating processing claims, as well as meeting defined scope, targets and SLAs.
• Collaborating with customers, business analysts, partners, and IT team members to understand business requirements that drive the innovation and quality. Concentrates on providing innovative solutions to more complex business needs.
• Providing required support for new joiners once they gain experience.
• Performs work in compliance with all Highmark and Highmark IT standards, policies and procedures.
• Effectively communicates with team members, customers, partners and management, including assisting with or conducting more complex walkthroughs, reporting production quality status.
• Other duties as assigned or requested.

Experience / Requirements

• Greater than 1.5 years of experience in claims adjudication
• Bachelors or Masters degree in any discipline
• Good verbal and written skills
• Good analytical and interpersonal skills
• Good to have: AHM or any equivalent certification
• Adjustments and Offset/Recovery knowledge