Claims Processor (healthcare domain only)

Job Title: Claims Processor

Location: Chennai | Thiruvananthapuram (TVM) | Bangalore | Kochi

About the Role

We are looking for a detail-oriented claims processor to handle healthcare insurance claims processing, validation, and adjudication support. The ideal candidate will have knowledge of healthcare claims workflows, insurance policies, eligibility verification, and claims documentation, with a strong focus on accuracy, productivity, and compliance with established procedures.

Key Responsibilities

• Process healthcare insurance claims accurately and within defined turnaround times.
• Review claims for completeness, accuracy, eligibility, and compliance with payer guidelines.
• Verify member information, coverage details, benefit limits, and provider information.
• Validate claim details against applicable medical policies, benefit plans, and contractual requirements.
• Identify missing information, discrepancies, duplicate claims, and potential processing errors.
• Process claims in accordance with established procedures and quality standards.
• Investigate rejected, denied, and pending claims and take appropriate corrective action.
• Route complex claims and exceptions to the appropriate teams for further review.
• Maintain accurate claim records and update information in claims processing systems.
• Meet established productivity, accuracy, and service-level targets.
• Follow data privacy, confidentiality, and regulatory compliance requirements, including applicable HIPAA guidelines.
• Coordinate with internal teams to resolve claim-related queries and processing issues.
• Participate in quality audits, training sessions, and process improvement initiatives.

Requirements & Tech Stack

• Experience in healthcare claims processing or medical insurance operations is preferred.
• Basic understanding of the US healthcare payer and provider ecosystem.
• Knowledge of the healthcare claims lifecycle, claim adjudication, and payment processes.
• Familiarity with member eligibility, benefits verification, and provider information.
• Basic knowledge of medical terminology and healthcare coding systems such as CPT, ICD-10, and HCPCS is an advantage.
• Good analytical skills and attention to detail.
• Basic computer proficiency and the ability to work with claims processing applications and MS Office.
• Good written and verbal communication skills.
• Ability to meet quality, productivity, and turnaround-time targets.
• Willingness to work in shifts, if required by business operations.

Preferred Qualifications

• Experience with healthcare claims administration platforms such as FACETS or similar systems.
• Knowledge of EDI healthcare transactions, including 837 claims and 835 remittance advice.
• Understanding of claim denials, adjustments, reprocessing, and appeals workflows.
• Experience in a healthcare BPO, insurance operations, or medical claims processing environment.