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.
  
  
  

Requirements

• Bachelor’s 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.