Associate - Claims (Appeals & Grievances) - US Healthcare

Job Description: Associate Claims Adjudication (Appeals & Grievances)

Location: OMR Navalur, Chennai, Tamil Nadu

Experience: 13 Years

Shift: US Shift (5:00 PM 2:00 AM IST)

Employment Type: FullTime

Role Overview:

We are looking for a detailoriented Associate Claims Adjudication with handson experience in Appeals and Grievances within US healthcare. The role involves reviewing, analyzing, and resolving appealed and grievance claims in compliance with payer guidelines, regulatory requirements, and internal SLAs.

Key Responsibilities:

• Adjudicate appeals and grievance claims accurately and within defined TATs
• Review medical records, claim history, EOBs, provider correspondence, and payer policies
• Interpret US healthcare policies, benefit plans, CPT, ICD10, and HCPCS codes
• Ensure compliance with CMS, HIPAA, and payerspecific guidelines
• Identify claim errors, root causes, and recommend corrective actions
• Document claim decisions clearly and maintain auditready records
• Meet productivity, quality, and accuracy benchmarks consistently
• Collaborate with QA, team leads, and downstream teams for issue resolution
• Escalate complex or highrisk cases appropriately

Required Skills & Qualifications:

• 13 years of experience in US healthcare claims adjudication
• Mandatory experience in Appeals and Grievances
• Strong knowledge of:
• Claims lifecycle and adjudication rules
• Medical coding (CPT, ICD10, HCPCS)
• Payer policies and benefit interpretation
• Good analytical and decisionmaking skills
• Strong written and verbal communication skills
• Comfortable working in US shifts
• Proficiency in claims processing systems and MS Office

Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels.