Assistant Manager – Claims Adjudication

Assistant Manager Claims Adjudication

Location: Infopark Kochi

Qualification: Any Degree

Experience: Minimum 5 Years

Salary: 10 LPA

Shift: 6:00 PM 3:00 AM

FACETS Experience: Preferred

Responsibilities

• Lead and manage a team handling US healthcare claims adjudication processes.
  
• Provide effective people management coaching mentoring and performance management to the team.
  
• Review and adjudicate US healthcare claims accurately in accordance with payer guidelines and client requirements.
  
• Verify member eligibility benefits coverage provider information and claim details.
  
• Analyze claims to determine appropriate payment denial adjustment or reprocessing.
  
• Handle claim adjustments corrections reprocessing and other complex claim-related issues.
  
• Investigate denied or rejected claims and ensure appropriate resolution within defined timelines.
  
• Maintain accurate documentation and ensure adherence to quality and compliance standards.
  
• Monitor team productivity quality SLA adherence and overall process performance.
  
• Manage attrition and shrinkage including tracking trends identifying root causes and implementing corrective actions.
  
  
  

• Bachelors degree or equivalent qualification in any discipline.
  
• Minimum 5 years of experience in US healthcare claims adjudication preferably with team-handling/leadership experience.
  
• Proven experience in team leadership and people management within a healthcare claims/BPO environment.
  
• Strong understanding of the US healthcare insurance and claims lifecycle.
  
• Good knowledge of eligibility benefits claims processing payment denials adjustments and reprocessing.
  
• Hands-on experience with FACETS is preferred
  
• Demonstrated experience in attrition and shrinkage management.
  
• Good communication and stakeholder-management skills.
  
• Ability to handle escalations and work effectively in a client-facing environment.