Roles and Responsibilities: • Process Adjudication claims and resolve for payment and Denials • Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process • Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations • Ensuring accurate and timely completion of transactions to meet or exceed client SLAs • Organizing and completing tasks according to assigned priorities. • Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team • Resolving complex situations following pre-established guidelines Requirements: • 1-3 years of experience in processing claims adjudication and adjustment process • Experience of Facets is an added advantage. • Experience in professional (HCFA), institutional (UB) claims (optional) • Both under graduates and post graduates can apply • Good communication (Demonstrate strong reading comprehension and writing skills) • Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.