Assistant Manager – Claims Adjudication / Adjustor

Job description

Job Description Assistant Manager – Claims Adjudication / Adjustor Function: Healthcare Location: Kochi Info Park, India Employment Type: Permanent Reports To: Manager / Senior Manager Shift: Night Shift Job Summary The Assistant Manager will be responsible for managing a team of 20–22 associates involved in US Healthcare Claims Adjudication and Adjustments. The role will oversee day-to-day operations, review complex claims and escalations, ensure quality and productivity, and deliver agreed client SLAs and business outcomes. The ideal candidate should have strong experience in end-to-end US Healthcare Claims Adjudication, Claims Review, or Adjustments, with proven team-handling experience. Key Responsibilities • Manage and provide operational support to a team of 20–22 Claims associates. • Review and resolve complex claims adjustments, escalations, and exceptions. • Ensure accurate and timely claims adjudication in line with client requirements, policies, contracts, and regulatory guidelines. • Monitor team performance against quality, productivity, accuracy, and SLA targets. • Review claims for appropriate coding, coverage, reimbursement, payment, development, or denial. • Identify and escalate issues related to system configuration, benefits, fee schedules, and adjudication inaccuracies. • Support processing and review of CMS-1500 and UB-04 claims. • Provide guidance on CPT, ICD-10, HCPCS, DRG, APC, Medicare, CCI edits, COB, and other claims-related requirements. • Analyze provider contracts, historical claims, and patient information to ensure payment accuracy. • Support client queries, escalations, audits, and regulatory requirements. • Conduct team meetings, calibrations, coaching, feedback, and performance discussions. • Identify process gaps and drive initiatives to improve workflow, productivity, and quality. • Support training, cross-training, and knowledge-sharing activities within the team. • Ensure adherence to HIPAA, company policies, SOPs, and regulatory requirements. • Promote teamwork and collaboration across internal and external stakeholders. • Perform other responsibilities assigned by management. Required Skills • Strong knowledge of US Healthcare Claims Processing and Adjudication. • Good understanding of medical terminology, coding, reimbursement, and healthcare insurance processes. • Working knowledge of CPT, ICD-10, HCPCS, DRG, APC, Medicare, COB, and CCI edits. • Experience with automated claims processing systems. • Strong analytical, problem-solving, and decision-making skills. • Excellent verbal and written communication skills. • Good knowledge of MS Office, particularly Excel, Word, PowerPoint, and Outlook. • Strong attention to detail and ability to manage multiple priorities. • Ability to coach, guide, and manage team performance effectively. Experience • 4–6 years of overall experience in US Healthcare Claims Processing, Adjudication, Adjustments, or Medical Billing. • Minimum 2–3 years of experience as an SME / Team Lead / Assistant Manager or equivalent leadership role. • Candidates should have demonstrated experience managing high-performing teams and meeting client SLAs, quality, and productivity targets. Education • Bachelor's degree with a minimum of 15 years of formal education. Key Competencies US Healthcare Claims | Claims Adjudication | Claims Adjustments | Team Management | Escalation Management | Medicare | Medical Coding | Quality Management | SLA Management | Process Improvement | Client Management | Coaching & Development Ability to commute/relocate: • Kochi, Kerala (Kochi): Reliably commute or planning to relocate before starting work (Required) Application Question(s): • What is the maximum team size you have handled ? Experience: • Claims: 4 years (Required) • Facet Application: 1 year (Required) Shift availability: • Night Shift (Required) • Overnight Shift (Preferred) Work Location: In person