Senior Process Associate - Claims Adjudicator

CogNet; Thiruvallur District; On-site; INR 500,000 - 800,000; Full time

Job summary

Cognet HRO in Ambattur, Chennai is seeking a Senior Process Associate for US Healthcare Claims Adjudication with 4–6 years of experience. You will handle end-to-end claims processing in line with CMS, HIPAA, and client policies.

Responsibilities include reviewing and adjudicating claims, verifying details, ensuring correct payments, and meeting SLA targets; you will work US day/night shifts from 6:30 pm to 3:30 am.

Qualifications

• 4–6 years of relevant experience in US Healthcare Claims Adjudication.
• Knowledge of CPT, ICD-10, HCPCS and medical terminology.
• Experience with denial management and appeals processing.
• Familiarity with payer policies and HIPAA guidelines.

Responsibilities

• Review and adjudicate insurance claims (medical/health/benefits) as per policy terms and procedures.
• Verify claim details, eligibility, coverage, and supporting documentation.
• Identify errors, discrepancies, and missing information; follow up as needed.
• Ensure accurate payment, denial, or adjustment of claims within defined SLAs.
• Calculate claim payments based on contracts and company rules.
• Meet productivity, quality, and turnaround time targets.
• Participate in audits, quality reviews, and process improvement initiatives.
• Confirm member eligibility, benefits, and required documents.
• Analyze existing processes and identify areas for optimization and efficiency gains.
• Update claim details and notes correctly in the system.

Skills

US healthcare claims adjudication

Claims processing

Analytical skills

Communication skills

Education

Any Graduate

Tools

MS Office

Claims processing systems

Job description

About Us

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

US Healthcare Claims Adjudication – Senior Process Associate

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 Claims Adjudication Specialist with strong knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.

Key Responsibilities

• Review and adjudicate insurance claims (medical/health/benefits) as per policy terms and procedures
• Verify claim details, eligibility, coverage, and supporting documentation
• Identify errors, discrepancies, and missing information; follow up as needed
• Ensure accurate payment, denial, or adjustment of claims within defined SLAs
• Calculate claim payments based on contracts and company rules
• Meet productivity, quality, and turnaround time targets
• Participate in audits, quality reviews, and process improvement initiatives.
• Confirm member eligibility, benefits, and required documents
• Analyze existing processes and identify areas for optimization and efficiency gains.
• Update claim details and notes correctly in the system

Skills Required

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

Required Skills

• Strong knowledge of US healthcare claims adjudication process.
• Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
• Experience in handling commercial, Medicare, and Medicaid claims.
• Knowledge of denials management and appeals processing.
• Familiarity with payer policies and insurance guidelines.
• Strong analytical and problem-solving skills.
• Good communication and interpersonal skills.
• Proficiency in MS Office and claims processing systems.

Eligibility Criteria

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

Preferred Skills

• Experience working with multiple payers and claim platforms.
• Exposure to quality audits and compliance processes.
• Ability to 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 period preferred.