Claims Adjudication

Coimbatore - India

Monthly Salary: Not Disclosed

Posted on: 8 hours ago

Vacancies: 1 Vacancy

Job Summary

Claims Adjudicator (2-7 Years Experience) - Coimbatore TN

We are seeking a meticulous and experienced Claims Adjudicator to join our team in Coimbatore Tamil Nadu. This is a proactive full-time opportunity for a professional dedicated to the accurate and efficient processing of insurance claims.

Responsibilities:

Review and adjudicate insurance claims in accordance with policy terms conditions and procedures.
Analyze claim documentation including medical records police reports and other relevant evidence to determine coverage and liability.
Process manual claims ensuring all required information is present and accurate.
Apply knowledge of the UAE claims process to ensure compliance with relevant regulations and standards.
Communicate effectively with policyholders healthcare providers and other stakeholders to gather necessary information and explain claim decisions.
Maintain accurate and detailed records of all claim activities and decisions within the claims processing system.
Identify potential fraudulent claims and escalate them for further investigation.
Collaborate with internal teams to ensure a seamless claims experience for our clients.
Stay updated on industry best practices regulatory changes and company policies related to claims adjudication.

Qualifications:

Minimum of 2 years and a maximum of 7 years of experience in claims adjudication or claims processing.
Proven expertise in handling manual claims.
Strong understanding of claims adjudication principles and practices.
Familiarity with the UAE claims process is essential.
Proficiency in using claims processing software and other relevant technological tools.
Excellent analytical critical thinking and problem-solving skills.
Exceptional attention to detail and accuracy.
Strong written and verbal communication skills in English.
Ability to work independently and as part of a team in a fast-paced environment.
Any relevant certification or degree in a related field is considered.

About the Role:

Apac Region Experience candidates only .

Manual Claims Adjudication experience

Job Description

Assess complex medical claims similar to AXA AIA Alliance Care
Verify medical codes diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9 ICD 10 CPT)
Review Clinical & Day Case claims and approve/reject basis the SOP
Review Hospital Inpatient & Outpatient Claims analyze the vouchers/medical documents categorize the benefits as per the SOP and approve/reject basis the SOP
Provide guidance and support to facilitate junior advisors resolve complex claims
Identify potential fraud waste and abuse (FWA) Flag suspicious cases highlight patterns and work with compliance teams to ensure early detection and escalation.

Questionnaire

Q1. What is Insurance Claim
Q2. What are the Steps of Claim used in Apac Region
Q3. What is your understanding about the Manual Claims adjudication
Q4. What is ICD9 and ICD10 give detailed answer on the same with examples of the work done by them the basic codes used universally needs to be mentioned correctly
Q5. Give an example of correct Diagnosis Interpretation

To Apply:

Interested candidates are encouraged to submit their resume and a cover letter detailing their relevant experience to .

Claims Adjudicator (2-7 Years Experience) - Coimbatore TN We are seeking a meticulous and experienced Claims Adjudicator to join our team in Coimbatore Tamil Nadu. This is a proactive full-time opportunity for a professional dedicated to the accurate and efficient processing of insurance claims. Res...