Manual Claims Adjudication (Insurance & Life Science) – APAC Region

• Review and adjudicate medical insurance claims in line with policy guidelines

• Validate member eligibility, coverage, and completeness of claims

• Interpret CPT, ICD10, and HCPCS codes to make accurate claim decisions

• Analyze clinical documents such as prescriptions, medical reports, and discharge summaries

• Identify errors or discrepancies and process claims within defined TAT

• Ensure compliance with quality standards and maintain data confidentiality (HIPAA)

• Coordinate with internal teams for claim clarifications and resolutions

• Support continuous improvement in claims adjudication processes