TM-Claims HC

Full-time Other-General

Job Summary This hybrid night shift role focuses on end to end health care claims adjudication and compliance driven processing using HIPAA standards within payer and provider environments ensuring accurate decisions reduced leakages and improved member and provider experience for a global client base while contributing to high quality timely claim outcomes and sustainable business value. Responsibilities Analyze complex health care claims with strong focus on HIPAA compliance and adjudication rules to deliver accurate and timely claim decisions that support client service excellence and financial integrity for payer and provider organizations.
Apply detailed knowledge of benefits coverage policies and coordination of benefits to interpret claim data and determine appropriate payment or denial outcomes that minimize rework and prevent revenue leakage.
Review claim edits audits and exception queues to validate rule application and propose refinements that enhance auto adjudication...