Senior Process Associate - Claims Adjudicator

CogNet; India; On-site; INR 600,000 - 900,000; Full time

Job summary

Cognet HRO in Chennai invites a Senior Process Associate to join our US Healthcare Claims Adjudication team. You will handle end-to-end claims processing, applying payer guidelines to ensure accurate adjudication of medical claims.

The ideal candidate has 4–6 years of US healthcare claims experience, working with CPT/ICD-10/HCPCS, and a focus on quality, compliance, and timely turnaround in a night or US day shift.

Qualifications

• 4–6 years of experience in US Healthcare Claims Adjudication.
• Experience with review and adjudication of medical claims.
• Experience handling commercial, Medicare, and Medicaid claims.
• Familiarity with payer policies and insurance guidelines.

Responsibilities

• Review and adjudicate insurance claims (medical/health/benefits).
• Verify claim details, eligibility, coverage, and documentation.
• Identify errors and follow up as needed.
• Ensure accurate payment, denial, or adjustment within SLAs.
• Participate in audits, quality reviews, and process improvements.
• Update claim details and notes in the system.

Skills

Claims processing

US healthcare knowledge

CPT ICD-10 HCPCS

Denials management

MS Office

Education

Any Graduate

Tools

Claims processing systems

Job description

Senior Process Associate - Claims Adjudicator

Cognet HRO is a leading Business Process Outsourcing Services Company providing full range of HR and F&A services to US based clients , With over 17 years of rich experience in Payroll Tax, Benefits S & HR Administration, Finance & Accounting , Sales Support . CogNet has been serving the PEO, ASO, HRO and HR Technology spaces since our inception. We help organizations extend their capabilities through simplified implementation, productivity performance measured to the minute, easy collaboration, and transparent pricing built around real time utilization.Our extensive expertise, data library, and workflow development tools accelerates the client implementation process.We have developed a deep expertise of process and technology in our Services , which allows us to rapidly deliver value to our clients. Cognet has been delivering outsourced solutions to the clients around the Globe.

Job Description

Job Title

Senior Process Associate

Experience Required

4 – 6 Years

Timing

6:30 pm - 3:30 am

Job Summary

We are looking for an experienced US Healthcare ClaimsAdjudication Specialist with strong knowledge in end-to-end claims processingand payer guidelines. The candidate will be responsible for adjudicatingmedical claims accurately while ensuring compliance with CMS, HIPAA, andclient-specific policies.

Key Responsibilities

• Review andadjudicate insurance claims (medical/health/benefits) as per policy terms andprocedures
• Verify claimdetails, eligibility, coverage, and supporting documentation
• Identify errors,discrepancies, and missing information; follow up as needed
• Ensure accuratepayment, denial, or adjustment of claims within defined SLAs
• Calculate claimpayments based on contracts and company rules
• Meetproductivity, quality, and turnaround time targets
• Participate inaudits, quality reviews, and process improvement initiatives.
• Confirm membereligibility, benefits, and required documents
• Analyze existingprocesses and identify areas for optimization and efficiency gains.
• Update claimdetails and notes correctly in the system

Skills Required

Proficiency in claims processing systems & Strong written and verbalcommunication skills & Strong knowledge of claims adjudication processesand benefit plans& US health Insurance Knowledge.

Required Skills

• Strongknowledge of US healthcare claims adjudication process.
• Goodunderstanding of CPT, ICD-10, HCPCS, and medical terminology.
• Experiencein handling commercial, Medicare, and Medicaid claims.
• Knowledgeof denials management and appeals processing.
• Familiaritywith payer policies and insurance guidelines.
• Stronganalytical and problem-solving skills.
• Goodcommunication and interpersonal skills.
• Proficiencyin MS Office and claims processing systems.

Eligibility Criteria

• AnyGraduate.
• 4 – 6years of relevant experience in US Healthcare Claims Adjudication.
• Experiencein handling high-volume claims processing environments preferred.

Preferred Skills

• Experienceworking with multiple payers and claim platforms.
• Exposureto quality audits and compliance processes.
• Abilityto work independently and manage priorities effectively.

Work Location

Ambattur, Chennai

Shift

US day shift / Night Shift

Notice Period

Immediate Joiners or candidates with short notice periodpreferred.