Claims Adjudicator

Gurugram, India

Calibrated Healthcare Network (CHN) is a decade old healthcare firm that provides a suite of services across three service lines; Healthcare Administration, Medical Management and Population Health Management. Calibrated’s unique Operating Model combines acclaimed clinical/operational leadership with a Hybrid Global Footprint to deliver distinctive value to clients. Our extensive and proven expertise in managed care sets us apart; managing over 11 million lives in over 8 states, with clients that include the dominant national and regional players in the industry

Position Purpose

At Calibrated, we are looking for experienced Claims Examiners/Claims Adjudicators to join our operations team in Gurugram who will directly work with the Claims Manager to process accurate claims according to regulatory guildelines.

Duties and Responsibilities

  • Evaluates and processes claims in accordance with company policies and procedures, CMS and DMHC guidelines
  • Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication
  • Exercises good judgment and remains knowledgeable in related company policies and procedures
  • Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing
  • Conveys a strong professional image, exhibits interest and positive attitude toward all assigned work

Education and Experience

  • Minimum 2 years of work experience in US Health care industry in Claims Adjudication
  • Extensive knowledge of Commercial, Medi-Cal/Medicaid and Medicare claims processing guidelines
  • Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc.
  • Knowledge of different providers’ payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.), preferred
  • Minimum Bachelor’s Degree

Resume/CV (Please upload only .doc, .pdf, .docx less than 10Mb)
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