Senior Health Claims Resolution Specialist

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. What We're Looking For 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 Know someone who would be a great fit Feel free to tag them or share this opportunity within your network.#Hiring #HealthClaims #ClaimsAdjudicator #InsuranceJobs #MedicalClaims #Healthcare #HealthInsurance #ClaimsProcessing #Recruitment #Jobs #ThaneJobs #Synergix #NowHiring .