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Adjudication against plan documents, plus appeals

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The Connext difference

By hiring and retaining the top 1% of global talent Connext build teams that drive innovation, maintain high standards, and deliver exceptional results.

Easilyscalable

We use AI and industry knowledge to find candidates fast, building your team in just 21 days on average.

Multi-countryoperations

With entities worldwide, we access the top 1% of talent and guide you to the best location or build multi-site teams.

Experience

We have over ten years of successful operations and industry experts on our team to ensure your success.

Datasecurity

Connext provides employee equipment, secure global facilities, and never stores your data offshore.

You keep the process. We keep the people.

Connext is not a hands-off vendor. Your team keeps control of the workflow, the quality standards and the reporting cadence. Connext recruits the staff, employs them in-country, and gives you an in-country team manager with weekly account reviews and direct reporting on quality and utilization.

21 days

average time to first hire

Send a job description and Connext handles sourcing, screening and onboarding from there.

Top 4%

of applicants endorsed

Candidates are vetted against your own job description before anyone reaches your desk.

$0

upfront recruitment cost

You pay for the dedicated team you build, month to month, with 30 days notice.

Appeals Specialist

Works the denials: corrects and resubmits claims, resolves discrepancies, and processes refund requests and settlements.

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SOC 2 Type II

HIPAA, with a signed BAA

No client data stored offshore

Roles we staff

Claims Adjudicator

Processes claims against your plan documents and policies, verifying that the data on the claim form is accurate and complete before it goes through.

  • Adjudication against plan documents and internal policy
  • Verification of claim form data before processing
  • Pricing and submission inconsistencies flagged to management

Claims Processor

Reviews submitted claims, calculates and processes payments, and follows up with payers and providers to unblock what is stuck.

  • Claim review, payment calculation and processing
  • Follow-up with payers and providers for missing information
  • Accurate records of claims information and transactions

Appeals Specialist

Works the denials: corrects and resubmits claims, resolves discrepancies, and processes refund requests and settlements.

  • Denial correction and corrected claim submission
  • Discrepancy resolution, refunds and settlements
  • Pre-processing errors resolved so claims are filed on time

Not sure which roles you need, or how many? Bring us the workload and we will map the team with you.

Book a meeting

CLIENT STORIES

Don't take our word for it.

Hear from the companies that made the switch and never looked back.

Company Client

Company Client

Company Client

Company Client

Company Client

Company Client

Neil Tagawa

CEO, RedHammer LLC

Ernest Sutton, CPA

Vice President, RediCarpet

COO

Fintech Company

VP of Strategy & Corporate Development

Software Company

Jamie Wiseman

Principal, Real Estate Development Firm

Senior Business Strategist

Transportation Company

Chief Operating Officer

Construction Company

SVP Operations

Software Company

Practice Manager

Services (non-Government)

Chief Executive Officer

Media Company

Managing Director

Investment Firm

Alison Inafuku

Accounting Manager, Tony Hawaii Automotive Group

Frequently asked questions

Is offshore claims processing HIPAA-compliant?

Yes, under a signed Business Associate Agreement, with SOC 2 Type II certified sites, documented and independently audited access controls, and no client data stored on offshore servers. Staff access is limited to the records and fields their assigned task requires.

Who sets the quality standards on claims adjudication?

You do. Under the co-management model your team keeps the process, the quality standards, and the reporting cadence, while Connext provides an in-country team manager and weekly account reviews covering quality and utilization.

What experience do your claims processors have?

Connext recruits claims staff with prior healthcare claims processing or medical billing experience, working knowledge of medical terminology, insurance billing codes, and reimbursement policies, plus familiarity with electronic medical records and claims processing software. Only the top 4% of applicants are endorsed to you after vetting.

Will an offshore team actually reduce our claims backlog?

That is the workload it is built for: researching and resolving pre-processing errors and edits so claims are filed on time, and flagging pricing or submission inconsistencies to management instead of letting them queue. Dedicated capacity with cover across shifts is what keeps the backlog from rebuilding.

Can offshore staff handle claim appeals and denials?

Yes. Appeals Specialists check claim statuses online, correct denied claims, resolve discrepancies, send corrected claims, and process refund requests or settlements. Timely appeals processing is also what keeps you inside each payer’s filing requirements.

What does an offshore claims adjudicator actually do?

A Claims Adjudicator processes claims against your plan documents while applying your policies and procedures, verifying that the data entered from the claim form is accurate and complete so the claim can be processed correctly. Coverage and eligibility determinations follow the policy terms, not the adjudicator’s judgement.

Teams  we can help you build
Every client receives the full suite of Connext outsourcing services, enabling you to easily build and manage your offshore team

Our case studies

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