Manager/ Senior Manager Non RCM

• As a Claim Adjudication Manager you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator.

Role

• Supervise claim adjudication staff to ensure claims are processed efficiently and accurately.
• Review complex or escalated claims and make final decisions on approvals or denials.
• Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers).
• Monitor team performance using KPIs (turnaround time, accuracy rate, etc.).
• Collaborate with medical coding, billing, provider relations, and legal teams as needed.
• Handle audits, quality assurance, and process improvement initiatives.
• Open for WFO/ Noida Extension Location/ Night shifts.