Senior Health Claims Adjudicator

We're Hiring | Senior Health Claims Adjudicator Location: Thane, Maharashtra Company: Synergix Services Private Limited Are you an experienced Health Claims Professional with expertise in adjudicating complex medical claims? We are looking for a Senior Health Claims Adjudicator to join our growing team and play a key role in delivering accurate, timely, and high-quality health claims processing. Key Responsibilities: ✔ Adjudicate complex local and overseas health claims, including hospitalization, surgery, radiation, and specialty services. ✔ Ensure claims are processed within established turnaround times. ✔ Interpret policy benefits and verify eligibility accurately. ✔ Coordinate with healthcare providers to obtain required medical documentation. ✔ Respond promptly to member and provider claim-related queries. ✔ Support provider payment processing, audits, and fraud detection initiatives. ✔ Provide technical support for provider portal submissions. ✔ Maintain compliance with company policies, regulatory requirements, and quality standards. ✔ Contribute to process improvement initiatives and special projects. Requirements: ✅ Bachelor's Degree in Applied Sciences or a related discipline (preferred). ✅ Minimum 3 years of experience in Health Claims Adjudication or a similar role. ✅ ACS, FLMI, and FLHC designations required. ✅ Certified Medical Coding credentials required. ✅ Strong analytical and mathematical aptitude. ✅ Ability to interpret insurance policies and medical documentation. ✅ Proficiency in Microsoft Office applications. ✅ Excellent communication, organizational, and problem-solving skills. What We're Looking For: Strong attention to detail and accuracy. Ability to manage multiple priorities in a fast-paced environment. High level of customer service and professionalism. Self-motivated with excellent decision-making skills. Commitment to confidentiality, quality, and continuous improvement. Interested candidates are invited to share their updated resume at: Know someone who would be a great fit? Feel free to tag them or share this opportunity within your network. Hiring HealthClaims ClaimsAdjudicator InsuranceJobs MedicalClaims Healthcare HealthInsurance ClaimsProcessing Recruitment Jobs ThaneJobs Synergix NowHiring