Claims Processing and Adjudication

Tata Consultancy Services; Mumbai; On-site; INR 900,000 - 1,200,000; Full time

Job summary

Tata Consultancy Services in Mumbai is seeking a seasoned benefits claims professional to efficiently process and adjudicate India-specific and global claims, ensuring accuracy and policy compliance.

You will validate documentation across claims such as gym reimbursements, vaccination, wellbeing, school reimbursements, and salary advances, collaborate with global stakeholders, and drive SLA and KPI adherence.

Qualifications

• 5–6 years of India/global claims processing and adjudication experience.
• Experience with benefits claims (gym, vaccination, wellbeing, school reimbursements, salary advances).
• Strong communication and documentation validation skills.
• Ability to collaborate with global stakeholders across regions.
• Understanding of SLAs and KPIs with a track record of meeting them.
• Fluency in English; Italian is a plus.

Responsibilities

• Efficiently process and adjudicate India-specific and global benefits claims.
• Validate claims documentation across multiple benefit types.
• Identify discrepancies and ensure timely resolutions.
• Collaborate with internal teams and external vendors and claimants.
• Monitor SLA and KPI performance and drive improvements.
• Ensure policy adherence and process improvements.

Skills

Italian Language

Claims processing

Documentation validation

Global stakeholder management

SLA adherence

English proficiency

Analytical skills

Education

Graduate in HR or related field

Tools

Darwin

Workday

ServiceNow (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:

• Proficiency in Italian Language (written and verbal)
• 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.