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
- Strong experience in claims adjudication, appeals & grievances (Payer Side) added advantage.
- Knowledge of Medicare, Medicaid, CMS, HIPAA, NCQA
- Experience in Member or provider appeals
- Good communication skills; able to handle escalations independently
Job Location: Firstsource Solutions Ltd. 5th Floor, ETA Techno Park, Block 4, OMR, Navallur, Chennai, 603103. Landmark: Near Vivira Mall
Shift Details
- Night Shift
- Must be flexible to work in any shift/timing
Cab Facility
- One-way drop cab provided
- Up to 30 km (doorstep service)
If interested, kindly share your updated CV with deepalakshmi.rrr@firstsource.com.
⚠️ Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or the deepalakshmi@firstsource.com email address.
…