Senior Health Claims Adjudicator

Synergix Services Private Limited · India

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.

✔ 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.

✅ 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.

• 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: esha.c@synergixserv.com

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