As aClaim Adjudication Manageryou are responsible for overseeing thereview and processing of insurance claimsto ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common inhealthcare, insurance, and third-party administrator.
Role
Supervise claim adjudication staffto ensure claims are processed efficiently and accurately.
Review complex or escalated claimsand make final decisions on approvals or denials.
Ensure compliance withregulatory and payer-specific guidelines(like Medicare, Medicaid, commercial insurers).
Monitor team performance usingKPIs(turnaround time, accuracy rate, etc.).
Collaborate withmedical coding, billing, provider relations, and legal teamsas needed.
Handleaudits, quality assurance, and process improvement initiatives.
Open for WFO/ Noida Extension Location/ Night shifts.
