Claims Specialist

Hexaware Technologies; United States; On-site; USD 36,000 - 48,000; Full time

Job summary

Hexaware Technologies is seeking a Service Delivery Executive in the United States to process healthcare claims and ensure timely adjudication aligned with group plans and client SLAs. You will review documents, verify eligibility, and communicate outcomes to stakeholders, while maintaining quality and accuracy.

Ideal candidates have a US-graduate background with 0–6 months of experience, a working knowledge of MS Office, and a commitment to deadlines and decisive judgment in a fast-paced

Qualifications

• US-based graduate, any degree: BSc/BCOM/BA or equivalent.
• 0–6 months of work experience preferred.
• Proficient in MS Office and general computer skills.

Responsibilities

• Reviewing healthcare claims and verifying submitted documents
• Ensuring compliance with adjudication policies and guidelines
• Identifying and flagging incomplete or incorrect claims
• Processing claims based on eligibility and policy terms
• Approving or rejecting claims as per defined authority levels
• Consulting with team leaders or subject matter experts for complex cases
• Informing stakeholders about claim decisions and outcomes
• Preparing and submitting adjudication performance reports

Skills

Computer Savvy

Education

Any Graduate or Equivalent (US)

Tools

MS Office

Job description

Education:

Mandatory: Any Graduate or Equivalent in the US. (BSC/BCOM/BA)

Job Description:

Position Objective:

As Service Delivery Executive the incumbent responsibility will be to process the claims (Claims Payment) and ensure that claims processed in a timely and according to the group/plan validation and also meet the client’s SLA in terms of TAT & Quality.

• Reviewing healthcare claims and verifying submitted documents
• Ensuring compliance with adjudication policies and guidelines
• Identifying and flagging incomplete or incorrect claims
• Processing claims based on eligibility and policy terms
• Approving or rejecting claims as per defined authority levels
• Consulting with team leaders or subject matter experts for complex cases
• Informing stakeholders about claim decisions and outcomes
• Preparing and submitting adjudication performance reports

Experience

• 0 to 6 Months organization’s work experience preferred

Technical Competencies: (Job related)

• Computer Savvy
• Should have working knowledge of MS-Office

Soft Skills: (Job related)

• Commitment to achieving deadlines
• Ability to make sound judgment and be decisive