Medical Claims Processor

TCS is hiring for Claims Adjudication Processor role

Location -Chennai

Job Summary:

We are seeking a detail-oriented and analytical Claims Adjudication Processor to join our team. The ideal candidate will be responsible for reviewing, processing, and resolving pending healthcare claims while ensuring compliance with federal, government, and commercial health plan policies. This role requires a strong understanding of medical claims processing, payer regulations, and industry guidelines.

Key Responsibilities:

• Process and adjudicate healthcare claims efficiently and accurately, ensuring compliance with company policies and industry standards.
• Investigate and resolve pended claims by reviewing documentation, identifying discrepancies, and taking necessary actions.
• Interpret and apply policies related to government (Medicare/Medicaid), federal, and commercial health plans.
• Research and analyze claims issues, including coding errors, missing information, and policy limitations, to determine appropriate resolutions.
• Work with internal teams, providers, and payers to ensure timely claim resolution.
• Maintain and update claims processing systems with accurate information.
• Ensure claims meet regulatory, contractual, and compliance requirements.
• Identify trends and escalate issues to management as needed.
• Meet quality and productivity standards set by the organization.

Qualifications:

• Experience: 18 to 24 months of experience in claims adjudication, processing, or related healthcare roles.
• Knowledge: Strong understanding of healthcare claims processing, including CPT, ICD-10, HCPCS codes, and industry regulations.
• Familiarity with government (Medicare/Medicaid), federal, and commercial health plans.
• Analytical Skills: Ability to identify and resolve claim discrepancies efficiently.
• Technical Skills: Proficiency in claims processing software and Microsoft Office Suite (Excel, Word, Outlook).
• Communication: Strong verbal and written communication skills for interacting with internal and external stakeholders.
• Attention to Detail: High level of accuracy and ability to manage multiple claims simultaneously.

Preferred Qualifications:

• Experience with claims systems such as Facets, NASCO, Amisys, or similar platforms.
• Knowledge of HIPAA regulations and healthcare compliance requirements.
• Prior experience in a high-volume claims processing environment.