Job Description

:
About The client :
A Fortune 500 global leader in technology services and digital business solutions, this company delivers comprehensive Business Process Services (BPS) and IT-enabled solutions. With a worldwide presence, it serves diverse industries including banking, healthcare, retail, manufacturing, and communications. The firm's expertise spans a broad spectrum of critical processes--from finance and accounting to human resources, customer service, and supply chain management - enabling clients to enhance efficiency, drive innovation, and achieve business agility on a massive scale.
Job Title: Healthcare Insurance Claims - Non-Voice Process
Role: Senior Process Executive (SPE) / Subject Matter Expert (SME)
Experience: Minimum 2+ Years (SPE) / Minimum 4+ Years (SME)
Shift: Hong Kong Shift
Work Mode: Work From Office (WFO) | 5 Days Working | Cab Provided
Notice Period: 0 - 45 Days
Location: Coimbatore, Tamil Nadu (Preferred candidates from here only)
About the Role
We are seeking skilled professionals to join our Healthcare Insurance Claims - Non-Voice team. This role involves end-to-end claims processing, validation, adjudication, and denial management for healthcare insurance claims. The position is purely non-voice and requires strong analytical skills, healthcare domain knowledge, and attention to detail to ensure accurate and timely claim resolution.
Key Responsibilities

• Process, validate, and adjudicate medical insurance claims (electronic and paper-based) as per payer rules and client guidelines.

• Ensure claims are coded correctly using ICD-10, CPT, and HCPCS standards before submission.

• Identify and correct data or coding discrepancies to maintain clean claim rates and reduce rework.

• Review and interpret EOBs (Explanation of Benefits), address denials, and initiate re-submissions or appeals where necessary.

• Perform claim follow-ups using payer portals and internal systems (no outbound/inbound calling required).

• Maintain detailed documentation and update claim status notes in the claims processing system.

• Escalate unresolved or complex issues to senior team members or team leads.

• Ensure compliance with HIPAA regulations, internal quality standards, and SLA metrics.

• Collaborate with cross-functional teams to identify process improvements and enhance claim accuracy.

Required Skills & Qualifications

• Bachelor's Degree / Diploma in Life Sciences, Healthcare, Commerce, or related discipline.

• Minimum 2 years (SPE) / 4 years (SME) of hands-on experience in Healthcare Insurance Claims Processing / Medical Billing / Revenue Cycle Management (RCM).

• Good understanding of ICD-10, CPT, HCPCS codes, and medical terminology.

• Familiarity with EDI 837 / 835 transactions, ERA/EOB reconciliation, and payer portal workflows.

• Strong analytical and problem-solving skills with attention to accuracy and turnaround time.

• Proficient in MS Excel, healthcare billing tools, and claim adjudication systems.

• Excellent written communication and documentation skills.

Preferred / Added Advantage

• Certification: CPC, COC, or CMRS.

• Prior experience with systems such as Optum, Trizetto, Availity, Epic, or Cerner.

• Experience in denial management, AR follow-up, or healthcare compliance auditing.

Key Performance Indicators (KPIs)

• Claims Accuracy Rate

• Clean Claim Rate (First Pass Rate)

• Denial Resolution Time

• Average Turnaround Time (TAT) per Claim

• Claims Processed per FTE per Day

Interview Mode : Online/Virtual
Requirements

Skills Required