Associate II - BPM - Claim Adjudication - Trivandrum
UST Global · Thiruvananthapuram · onsite · Posted 43d ago
Undisclosed2–7 yrsfulltimeSourced from
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About this role
Claims Adjudication / Denial Management
Location: Trivandrum, Kerala
Experience: 2-7 Years
Skill: Claim Adjudication / Denial Management
Experience: 2-7 Years
Skill: Claim Adjudication / Denial Management
Job Summary
We are looking for professionals with 2-7 years of experience in US Healthcare Claims Adjudication and/or Denial Management . The candidate will be responsible for reviewing healthcare claims, identifying errors or discrepancies, resolving claim denials, and ensuring accurate and timely claim processing.
Key Responsibilities
- Review and adjudicate healthcare claims according to payer policies, client guidelines, and regulatory requirements.
- Analyze denied and rejected claims to identify the root cause of denials.
- Work on denial management, including researching, correcting, and resubmitting claims.
- Verify member eligibility, benefits, coding, billing information, and claim documentation.
- Identify trends and recurring issues contributing to claim denials.
- Coordinate with internal teams such as coding, billing, and AR teams to resolve claim-related issues.
- Maintain accuracy and productivity while meeting defined SLAs and quality targets.
- Document claim decisions, denial reasons, actions taken, and resolution details accurately.
- Ensure compliance with HIPAA and other applicable healthcare regulations.
- Escalate complex or unresolved claims to the appropriate team or supervisor.
Required Skills
- 2-7 years of relevant experience in US Healthcare Claims Adjudication / Denial Management .
- Good understanding of the US healthcare revenue cycle and claims process.
- Knowledge of claim forms such as CMS-1500 and UB-04 .
- Understanding of insurance plans, eligibility, benefits, CPT, HCPCS, ICD-10, and modifiers.
- Strong analytical and problem-solving skills.
- Good written and verbal communication skills.
- Ability to analyze denial codes and determine appropriate resolution.
- Good working knowledge of MS Office and healthcare claims-processing systems.
Preferred Skills
- Experience working with US healthcare payers/TPAs.
- Knowledge of denial codes, payer guidelines, and appeals processes.
- Experience with claims adjudication platforms or healthcare RCM tools.
- Ability to handle high-volume claims while maintaining quality and accuracy.
Education
- Any graduate degree is preferred.
- Relevant experience in US Healthcare/RCM/Claims Processing will be considered.
Job Location: Trivandrum, Kerala
Experience: 2-7 Years
Employment Type: Full-time
Experience: 2-7 Years
Employment Type: Full-time
Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.
Sourced from naukri
Skills
CMShcpcsDenial ManagementhipaaBpmAdjudicationClaim AdjudicationmodifiersHealthcareCommunication SkillscomplianceClaims Processing
About UST
UST Global
IT Services & Consulting
14.0k+
employees
1999
27 years old
Aliso Viejo, California
US
₹12.9L PA avg
Avg at UST
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