Claims Adjudication Specialist

Tata Consultancy Services; Mumbai; On-site; INR 900,000 - 1,300,000; Full time

Job summary

Tata Consultancy Services is seeking an experienced claims processing professional to adjudicate India-specific and global benefits claims and ensure policy compliance. The role requires 5–6 years of experience in claims processing, strong English communication, and a proven ability to work with global stakeholders to meet SLA/KPI targets.

The position is based in Mumbai with on-site operations. Working hours accommodate regional coverage with a 24/7 service delivery model and on-site presence

Qualifications

• Graduate with specialization in Human Resources.
• 5–6 years of India/global claims processing and adjudication experience.
• Fluent English with cross-regional collaboration experience.
• Experience verifying and validating claim-related documents.

Responsibilities

• Process and adjudicate India-specific and global benefits claims.
• Validate claims documentation including gym, vaccination, wellbeing, school reimbursements, and salary advance claims.
• Identify discrepancies and ensure timely resolutions.
• Collaborate with global stakeholders to align processing practices.
• Ensure SLA and KPI adherence and drive process improvements.

Skills

Claims processing

Global stakeholder management

Documentation validation

Communication skills

Analytical skills

SLA & KPI management

Process improvement

Education

Graduate in Human Resources

Tools

Darwin

Workday

SNOW

Job description

• Efficiently process and adjudicate India-specific and global benefits claims, ensuring accuracy and compliance with policies.
• Validate claims documentation, including gym reimbursement claims, vaccination claims, wellbeing benefits claims, school reimbursement claims, Salary advance claims etc. for global regions
• Identify discrepancies in claims and ensure timely resolutions in line with company guidelines
• Experience in similar claim processing is a must
• Knowledge and working experience of Darwin and Workday is a plus
• Knowledge of ticket management tools like SNOW is a Plus.
• Stakeholder Engagement:
• Collaborate with global stakeholders to align claims processing practices with global standards.
• Communicate effectively with internal teams, external vendors, and claimants to ensure smooth claim management.
• SLA & KPI Management:
• Demonstrate a strong understanding of Service Level Agreements (SLAs) and Key Performance Indicators (KPIs).
• Consistently meet or exceed SLA requirements for claims processing while maintaining high-quality standards.
• Policy Adherence & Process Improvement:
• Ensure adherence to company policies, local regulations, and international best practices in claims management.
• Proactively identify and recommend process improvements to enhance efficiency and accuracy.

Qualification & Skillset:

• Graduate and specialization in Human resources
• 5–6 years of experience in India / Global claims processing and adjudication.
• Strong understanding of various types of claims, advances , reimbursements and benefits eligible for claims
• Expertise in verifying and validating claim-related documents.
• Exceptional command of English, with the ability to communicate fluently and professionally.
• Proven experience collaborating with global stakeholders across regions.
• Deep understanding of SLAs and KPIs and a track record of achieving or exceeding them.

Key Skills:

Claims Processing experience including gym reimbursement claims, vaccination claims, wellbeing benefits claims, school reimbursement claims, Salary advance claims etc. for global regions

• Knowledge of Darwin and Workday tool – is an advantage
• Documentation Validation
• Global Stakeholder Management
• Process Improvement and Compliance
• SLA & KPI Adherence
• Excellent Communication and Analytical Skills

Working Conditions:

• Work Shift will be dependent on geography/region coverage requirements across a 24-hour * 7 service delivery
• Work from Office (No work from home)
• Agile to extended work hours when needed to meet deadlines without prompting.