SPE/SME – Claim Adjudication / Medical Coder / Manual Claims (APAC)

• Assess complex medical claims for APAC region clients

• Verify medical codes, diagnosis, and procedures for compliance with industry standards (ICD-9, ICD-10, CPT)

• Review Clinical & Day Case claims, and approve/reject based on SOPs

• Review Hospital Inpatient & Outpatient claims, analyze medical documents, categorize benefits, and approve/reject per SOP

• Provide guidance and support to junior advisors in resolving complex claims

• Identify potential fraud, waste, and abuse (FWA); flag suspicious cases and work with compliance teams

• Manual Claims Adjudication experience required