SPE/SME – Claim Adjudication / Medical Coder / Manual Claims (APAC)

Assess complex medical claims for APAC region clients

Verify medical codes, diagnosis, and procedures for compliance with industry standards (ICD-9, ICD-10, CPT)

Review Clinical & Day Case claims, and approve/reject based on SOPs

Review Hospital Inpatient & Outpatient claims, analyze medical documents, categorize benefits, and approve/reject per SOP

Provide guidance and support to junior advisors in resolving complex claims

Identify potential fraud, waste, and abuse (FWA); flag suspicious cases and work with compliance teams

Manual Claims Adjudication experience required