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Manager / Senior Manager Non RCM
ConfidentialNoida1 day ago
Job descriptionAs a Claim Adjudication Manager you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator.
Role
- Supervise claim adjudication staff to ensure claims are processed efficiently and accurately.
- Review complex or escalated claims and make final decisions on approvals or denials.
- Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers).
- Monitor team performance using KPIs (turnaround time, accuracy rate, etc.).
- Collaborate with medical coding, billing, provider relations, and legal teams as needed.
- Handle audits, quality assurance, and process improvement initiatives .
- Open for WFO / Noida Extension Location / Night shifts.
Skills Required
Risk Assessment, Project Management, Data Analysis, Financial Modeling, Stakeholder Management, Strategic Planning
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Senior Manager • Noida