About the Role
Job Description
We are seeking an experienced Senior Associate - Claims ,Appeals & Grievances to join our US Healthcare Payer Operations team in Chennai. The ideal candidate will have strong expertise in member and provider appeals , grievance resolution , and CMS-compliant determinations and ensure adherence to regulatory timelines and quality standards.
Key Responsibilities
- End-to-end claims adjudication, appeals & grievances (added advantage) processing (Payer Side)
- Review and resolve member and provider appeals
- Issue CMS-compliant determinations for Medicare & Medicaid
- Coordinate with UM, Medical Review, Claims, and Provider Relations
- Ensure TAT/SLA adherence and maintain case documentation
Required Skills & Experience
- 1-4 years in US healthcare payer operations
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