Wellcove is hiring fresh graduates for the Claim Adjudicator profile within the E2E Claims department. The role involves reviewing and analyzing medical documentation, evaluating healthcare claims, interpreting medical coding systems, and accurately processing complex claims.
The position is remote and requires candidates to work in a mandatory US-timing night shift.
Job Details
| Details | Information |
|---|---|
| Company | Wellcove |
| Position | Claim Adjudicator |
| Department | E2E Claims |
| Work Mode | Remote |
| Experience | Freshers |
| Eligible Batches | 2025 and 2026 graduates |
| Shift | Pure Night Shift |
| Shift Timing | 5:30 PM to 2:30 AM |
| Reporting To | Team Leader (B2) |
Position: Claim Adjudicator
The Claim Adjudicator is responsible for the investigation, adjudication, and processing of complex healthcare claims while following industry regulations and organizational policies.
Candidates will review medical records, healthcare coding information, policy documents, and other relevant information to make accurate claim decisions.
Responsibilities
- Review and analyze complex medical documentation accurately to prevent errors in claims processing.
- Evaluate claims against established guidelines, contracts, and regulatory requirements.
- Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios.
- Analyze medical records, policy documents, and relevant information to make informed claim decisions.
- Interpret healthcare coding systems including CPT, ICD-10, HCPCS, and Revenue Codes.
- Apply knowledge of healthcare benefits and payment policies.
- Provide clear and concise explanations of claim decisions.
- Identify trends and patterns in complex claims to contribute to process improvements.
- Correctly calculate claim amounts for customers.
- Comply with company regulations related to HIPAA, confidentiality, and private health information.
Eligibility / Qualifications
Candidates should be:
- BPT graduates
- B.Pharm graduates
- Life Science graduates
- Freshers from the 2025 and 2026 batches
Required Skills
Medical & Healthcare Knowledge
- Strong medical science knowledge to comprehend medical reports.
- Understanding of medical terminology and human anatomy.
- Knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
- Understanding of inpatient vs. outpatient claims.
- Ability to interpret medical procedures and diagnoses.
Communication Skills
- Strong English comprehension.
- Strong verbal and written English skills.
Analytical & Reasoning Skills
- Good English comprehension and analytical skills.
- Excellent problem-solving ability.
- Strong attention to detail.
- Ability to review complex information accurately.
Mathematical Skills
- Basic mathematical knowledge.
- Ability to calculate simple interest and compound interest.
- Ability to correctly calculate claim amounts.
Work Environment & Shift Requirements
Candidates should be open to working 24/7 operations and mandatory US timings. The position requires a pure night shift from 5:30 PM to 2:30 AM.
Candidates should also be ready to handle work pressure and complete deliverables within timelines.
Application Details
Mail Ur Resume & details : Akriti.Negi@chcs-services.com