10/04 Bulbul Ray Nathan
Head Human Resource at Connect & Heal

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Medical Adjudicator - Insurance (2-3 yrs)

Bangalore Job Code: 23950

Medical Adjudicator


- Manage the adjudication of prescription orders

- Conversion of inbound request into completed orders

- Coordinate the scheduling and fulfillment of diagnostic tests and procedures prescribed by healthcare providers

- Workflow Optimization

- Compliance and Quality Assurance

- Customer Service and Stakeholder Engagement

Claims Processing: Reviewing and adjudicating healthcare claims(cashless + reimbursement) according to established guidelines and policies.

Customer Service: Responding to inquiries and concerns from customers and providing timely and accurate information

- Assisting customers with navigating the claims process, understanding their insurance benefits, and resolving any issues or concerns they may have.

Documentation and Reporting:

- Maintaining detailed and accurate records of claim adjudication activities, customer interactions, and resolution outcomes.

Collaboration and Training:

- Collaborating with internal teams, including claims processors, billing specialists, and quality assurance personnel, to ensure consistent and efficient claims processing.

Qualifications:

- Bachelor in Pharmacy/- MBBS or parallel medical background

- Knowledge of diagnostics and medicines

- Prior experience in OPD Insurance/ TPA/ Healthcare Aggregator

- Previous experience in healthcare claims processing, medical billing, or insurance administration required.

- Strong understanding of medical terminology, coding systems (e.g., ICD-10, CPT), and healthcare reimbursement principles.

- Excellent communication skills, both verbal and written

- Proficiency in using computer software and databases

- Attention to detail, analytical thinking, and problem-solving abilities.

- Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.

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