Claim Adjudication

Claims Adjudication

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Avinica' approach to claims adjudication is straightforward - utilize a skilled group of offshore professional claims adjudicators, an operations group and a team of experienced IT professionals to deliver extraordinary service to Healthcare payers. Avinica' secure, outsourced solution will facilitate an adjudication cost savings of at least 30%.

Professional Adjudicators

All Avinica healthcare professionals are trained on multiple adjudication platforms and plan designs. Our adjudicators are highly educated people with knowledge of medical terminology and who are proven analytical problem solvers. New adjudicators are trainded in an intensive program covering the U.S. healthcare industry and claims adjudication. The program is administered by senior level U.S. based claims adjudicators who also serve as claim auditors.

Client Specific Training

Certified claims adjudicators go through client specific training to learn the client’s insurance plans, systems and claim types. Avinica works with the client to create a detailed project plan, verify the requirements and determine the critical success factors that need to be met and signed off to exit this phase of the project. In addition, a comprehensive communication plan is developed to define the communication channels and to review status, issues and amendments to plans. A dedicated Project Manager manages the entire process.

During client specific training, our operation begins with full supervision and 100% claim review until the team in training becomes proficient. Once training is successfully completed and signed off, the team will earn client certification.

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