US Healthcare

Guideline Inc; Hyderabad; On-site; INR 450,000 - 644,000; Full time

Job summary

Guideline Inc. in India invites experienced professionals for US Healthcare Claims Adjudication across Hyderabad, Chennai and Coimbatore. This office-based role requires accuracy, HIPAA compliance, and adherence to client guidelines.

You'll process and adjudicate claims, verify member and provider data, and meet quality and turnaround targets on US shift hours.

Qualifications

• Qualification: Any Graduate
• Experience: Relevant experience in US Healthcare Claims Adjudication
• Notice Period: Immediate Joiners Only

Responsibilities

• Review and adjudicate US Healthcare medical claims based on defined guidelines.
• Validate member, provider, procedure, diagnosis, authorization, and benefit information.
• Process claims according to payer policies, contracts, and benefit plans.
• Identify and resolve claim errors, discrepancies, and exceptions.
• Handle claims involving inpatient, outpatient, professional, and facility services.
• Ensure accurate application of deductibles, copayments, coinsurance, and benefit limits.
• Identify claims requiring additional information or manual review.
• Meet defined quality, productivity, and turnaround-time (TAT) targets.
• Follow HIPAA, compliance, and client-specific requirements.

Skills

US Healthcare Claims Adjudication

Education

Any Graduate

Job description

Were Hiring | US Healthcare Claims Adjudication

Exciting opportunities for experienced professionals in US Healthcare Claims Adjudication across multiple locations!

• Mandatory Skill: US Healthcare Claims Adjudication
• Job Locations: Hyderabad | Chennai | Coimbatore
• Work Mode: Work from office
• Shift: US Shifts

Experience & Compensation

SPE: 1.64 years 4.5 LPA

SME: 4.56 years 6.44 LPA

Role Claims Adjudication

The candidate will be responsible for processing and adjudicating US Healthcare claims accurately and efficiently while ensuring compliance with payer/client guidelines.

Key Responsibilities:

• Review and adjudicate US Healthcare medical claims based on defined guidelines.
• Validate member, provider, procedure, diagnosis, authorization, and benefit information.
• Process claims according to payer policies, contracts, and benefit plans.
• Identify and resolve claim errors, discrepancies, and exceptions.
• Handle claims involving inpatient, outpatient, professional, and facility services.
• Ensure accurate application of deductibles, copayments, coinsurance, and benefit limits.
• Identify claims requiring additional information or manual review.
• Meet defined quality, productivity, and turnaround-time (TAT) targets.
• Follow HIPAA, compliance, and client-specific requirements.
• Handle escalations and coordinate with relevant teams for claim resolution.

For SME Roles

• Handle complex claims and escalations.
• Support team members with process and claims-related queries.
• Monitor team performance and ensure productivity and quality targets are achieved.
• Conduct process briefings and knowledge-sharing sessions.
• Assist with people management and day-to-day team coordination.
• Identify process gaps and recommend improvements.

Eligibility

• Qualification: Any Graduate
• Experience: Relevant experience in US Healthcare Claims Adjudication
• Notice Period: Immediate Joiners Only
• Candidates with hands-on experience in US Healthcare Claims Processing / Claims Adjudication are preferred.

Key Requirement

Strong hands-on experience in US Healthcare Claims Adjudication is mandatory.