Claims Specialist

Aptita · India

Position: Claims - TL-TM-SME

Location: Kochi / Pune

Night Shift - WFO

Healthcare Operations leader with 6+ years of experience in U.S. payer-side healthcare operations across Medicare, Medicaid, Commercial, business, Claims Adjudication, Clean Claims Processing

Responsible for keying,processing and/or adjusting healthclaims inaccordance with claims policies and procedures

Good understanding of the application of benefit contracts, pricing , processing,policies procedures, govt regs, coordination of benefits, & amp; healthcare terminology.

Monitor team performance metrics including [AHT, claim resolution rate, patient satisfaction]. Coach, mentor, and develop staff through regular training and performance evaluations. Collaborate with clinical and operational teams to ensure alignment with healthcare regulations (e.g., HIPAA, Claims adjudication, Case Management).

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