Senior Associate

Job Description

We are seeking an experienced Senior Associate - Claims ,Appeals & Grievances to join our US Healthcare Payer Operations team in Chennai. The ideal candidate will have strong expertise in member and provider appeals, grievance resolution, and CMS-compliant determinations and ensure adherence to regulatory timelines and quality standards.

Key Responsibilities

• End-to-end claims adjudication, appeals & grievances (added advantage) processing (Payer Side)
• Review and resolve member and provider appeals
• Issue CMS-compliant determinations for Medicare & Medicaid
• Coordinate with UM, Medical Review, Claims, and Provider Relations
• Ensure TAT/SLA adherence and maintain case documentation

Required Skills & Experience

• 1-4 years in US healthcare payer operations
• Strong experience in claims adjudication, appeals & grievances (Payer Side) added advantage.
• Knowledge of Medicare, Medicaid, CMS, HIPAA, NCQA
• Experience in Member or provider appeals
• Good communication skills; able to handle escalations independently

Job Location: Firstsource Solutions Ltd. 5th Floor, ETA Techno Park, Block 4, OMR, Navallur, Chennai, 603103. Landmark: Near Vivira Mall

Shift Details

• Night Shift
• Must be flexible to work in any shift/timing

Cab Facility

• One-way drop cab provided
• Up to 30 km (doorstep service)

If interested, kindly share your updated CV with deepalakshmi.rrr@firstsource.com.

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 or the deepalakshmi@firstsource.com email address.