Analyst I - Adverse Action Adjudicator

Darwinbox Digital Solutions Pvt. Ltd.; India; On-site; INR 400,000 - 600,000; Full time

Job summary

HCA Healthcare is seeking an Adverse Action Adjudicator to review case requirements, assess eligibility, verify alignment with disclosures and background results. You will apply the adjudication matrix to render objective decisions while remaining neutral and free of conflicts of interest.

You will also maintain complete adjudication records, collaborate with Legal, Ethics and Compliance, HR Business Partners, and other stakeholders, and monitor regulatory developments impacting adjudication

Qualifications

• Bachelor's degree required.
• Minimum of 1 year of relevant professional experience (required).
• Proficiency with computers and business software applications.
• Strong written communication skills.

Responsibilities

• Review the position requirements associated with each case, including minimum qualifications and required pre-employment verifications, and compare them with the candidate's consent form, resume, disclosures, and background investigation results to confirm alignment and completion.
• Evaluate discrepancies or omissions between information disclosed by the candidate and information verified through the background investigation, including whether nondisclosure affected the scope of screening, and apply the adjudication matrix to determine the appropriate course of action.
• Consult with the background investigation vendor and/or the subject of the investigation, as needed, to clarify relevant facts and circumstances.
• Render approval or denial decisions in accordance with the adjudication matrix and, as applicable, relevant laws, regulations, policies, precedent, and informed assessment of potential risk to the employer.

Skills

Problem solving

MS Office

Written communication

Computers & software

Education

Bachelor's degree

Job description

Reviews theposition requirements associated with each case, including minimumqualifications and required pre-employment verifications, together withcandidate disclosures, consent forms, resumes, and background investigationresults to determine whether requirements are met and information aligns.Applies the established adjudication matrix and renders objective, impartialdecisions based on the facts presented. The Adverse Action Adjudicator mustremain neutral and free of conflicts of interest while determining whetherdiscrepancies, omissions, or unmet requirements are sufficient to disqualifya candidate from employment.

Responsibilities:

Major Responsibilities

• Review the position requirements associated with each case, includingminimum qualifications and required pre-employment verifications, andcompare them with the candidate's consent form, resume, disclosures, andbackground investigation results to confirm alignment and completion.
• Evaluate discrepancies or omissions between information disclosed by thecandidate and information verified through the background investigation,including whether nondisclosure affected the scope of screening, and applythe established adjudication matrix to determine the appropriate course ofaction.
• Consult with the background investigation vendor and/or the subject of theinvestigation, as needed, to clarify relevant facts and circumstances.
• Render approval or denial decisions in accordance with the adjudicationmatrix and, as applicable, relevant laws, regulations, policies, precedent,and informed assessment of potential risk to the employer.

Governance & Compliance

• Periodically review the adjudication matrix used by Recruiting andrecommend revisions as appropriate.
• Create and maintain complete records of adjudication decisions, includingthe rationale supporting each course of action.
• Develop and maintain adjudication analytics to support reporting andinformed decision-making.
• Safeguard the confidentiality of all adjudication materials and relatedinformation.
• Recommend improvements to adjudication processes, products, and services.
• Exercise independent judgment and operate with minimal supervision in acomplex environment.
• Conduct investigations and recommend resolutions in collaboration withLegal, Ethics and Compliance, Human Resources Business Partners, and otherstakeholders as appropriate.
• Monitor emerging business challenges and regulatory developments that mayaffect adjudication practices.

Other

• Perform other duties as assigned.
• Adhere to HCA Healthcare's Code of Conduct, Mission, and Values.

Education& Experience:

• Bachelor's degree (required)
• Minimum of 1 year of relevant professional experience (required)

MustHave Skills

• Demonstrated ability to solve unique and complex problems with broad businessimpact
• Proficiency with computers and business software applications
• Strong proficiency in Microsoft Office, including Outlook, Word, and Excel
• Strong written communication skills

Knowledge,Skills, Abilities, Behaviors:

Service and Quality Excellence

Demonstrates an unwavering commitment to delivering exceptional care andcreating an unmatched value proposition for patients.

Required

Honor our Mission and Values

Builds trust and acts authentically to foster a culture of integrity,inclusion, and mutual respect.

Required

Effective Decision Making

Makes timely, informed decisions that support the best interests ofpatients, employees, providers, the community, and HCA.

Required

Attain and Leverage StrategicRelationships

Develops and strengthenscollaborative relationships with internal and external stakeholders toadvance patient care and support the growth of HCA.

Required

Lead and Develop Others

Leads others to achieve organizational goals and objectives while providingmeaningful coaching and mentoring to strengthen individual and teamcapabilities and drive employee engagement.

Required

Communicate with Impact

Communicates information clearly, concisely, and persuasively to engageothers effectively and achieve desired results.

Required

Achieve Success through Change

Identifies opportunities for improvement and innovation, addresses barriersand resistance, and enables desired behaviors.

Required

Drive Execution and FinancialResults

Demonstrates commitment to HCA'ssuccess and financial well-being by setting high standards and holding selfand others accountable for achieving results.

Required

Strategic Positioner

Positions the business for sustained success within its market.

Required

Credible Activist

Builds trusted relationships through a proactive, informed point of view.

Required

Paradox Navigator

Effectively manages competing business priorities and tensions, balancinglong- and short-term needs as well as top-down and bottom-up perspectives.

Required

Culture and Change Champion

Drives effective change and supports the management and evolution oforganizational culture.

Required

Human Capital Curator

Manages the flow of talent by developing employees and leaders, drivingindividual performance, and building technical capability.

Required

Total Reward Steward

Supports employee well-being through the effective use of financial andnonfinancial rewards.

Required

Technology and Media Integrator

Uses technology and social media to enable and strengthen high-performingorganizations.

Required

Analytics Designer and Interpreter

Uses analytics to improve the quality and effectiveness of decision-making.

Required

Compliance Manager

Manages compliance-related processes in accordance with applicableregulatory guidelines.