Claims Supervisor

The Cigna Group; Bengaluru; On-site; INR 900,000 - 1,300,000; Full time

Job summary

The Cigna Group in Bangalore is seeking a Claims Supervisor to lead a team responsible for accurate and timely processing of healthcare claims (professional/institutional) while ensuring adherence to client policies, regulatory requirements, and internal quality standards.

You will focus on daily operations management, team performance, quality/compliance, production attainment, people leadership, and continuous improvement across claims processing workflows, with emphasis on audits, coaching,

Qualifications

• 5–6 years of experience in International Healthcare Claims Operations (payer/TPA/provider revenue cycle claims teams supporting payer processes).
• Minimum 3–4 years in a lead/team supervisor/team lead role.
• Strong understanding of claims concepts: adjudication flow, denials, adjustments, benefits/eligibility basics.

Responsibilities

• Lead the team to meet SLA/TAT, productivity, and quality targets.
• Allocate work, manage volumes, ensure queue hygiene and timely completion of deliverables.
• Provide floor support and real-time resolution for processing queries and escalations.
• Oversee claims processing (technical & functional) and guide handling across intake, validation, adjudication, pends, corrections and COB.
• Ensure HIPAA/privacy norms and internal data handling guidelines are followed.

Skills

Team Leadership

Operations Management

Quality Assurance

MS Office

Dashboards & Tracking

Education

Graduate (Any) – medical, Paramedical, Commerce, Statistics, Mathematics, Economics or Science

Tools

MS Excel

PowerPoint

Job description

Process Overview

Global insurance claims processing for individual, employer and group.

Job Description

The Claims Supervisor will lead a team responsible for accurate and timely processing of healthcare claims (professional/institutional) while ensuring adherence to client policies, regulatory requirements, and internal quality standards. This role focuses on daily operations management, team performance, quality/compliance, production attainment, people leadership, and continuous improvement across claims processing workflows.

Responsibilities

• Team Leadership & Daily Operations
• Supervise day‑to‑day claims processing operations to meet SLA/TAT, productivity, and quality targets.
• Allocate work, manage volumes, and ensure queue hygiene, balanced distribution, and timely completion of deliverables.
• Provide floor support and real‑time resolution for processing queries and escalations.
• Claims Processing Oversight (Technical & Functional)
• Guide the team on claims handling across key areas such as:
  • Claims intake, validation, adjudication support and pends
  • Error identification and correction, resubmissions, and recoupment workflows (as applicable)
  • Coordination of Benefits (COB)
• Ensure correct application of standard claims concepts (as applicable to process):
  • Eligibility, benefits, pre‑auth/referrals, medical necessity indicators
  • Code familiarity: CPT/HCPCS/ICD‑10 (conceptual), modifiers, NCCI awareness (nice‑to‑have)
• Quality, Compliance & Audit Readiness
• Drive adherence to SOPs, WIs, and control checks; ensure zero‑tolerance compliance items are met.
• Conduct regular audits/quality calibrations, coach for error reduction, and maintain documentation for governance.
• Ensure process alignment with HIPAA/privacy norms and internal data handling guidelines.
• Performance Management & Coaching
• Set clear expectations, conduct huddles/1:1s, and provide ongoing coaching on quality, productivity, and behaviors.
• Create development plans for team members; identify training needs and coordinate refreshers.
• Manage attendance, schedule adherence, and engagement levers; address performance gaps through structured action plans.
• Stakeholder & Client Communication
• Provide daily/weekly operational updates to managers and cross‑functional teams (Quality, Training, WFM, Tech).
• Participate in client calls as needed, share performance narratives, and support action plan tracking.
• Drive effective escalation management with clear RCA and preventive actions.
• Continuous Improvement (CI) / Automation Mindset
• Identify defect trends, run basic analysis, and implement corrective/preventive actions.
• Lead mini‑projects to improve First Pass Yield (FPY), reduce rework, and improve throughput.
• Support digitization/automation initiatives (macros, workflow improvements, knowledge articles) in partnership with OE/Tech.

KPIs

• SLA / TAT adherence (queue‑based and end‑to‑end as applicable)
• Productivity / throughput per FTE
• Quality score / audit compliance / error rate
• Rework reduction, FPY improvement
• Shrinkage/attendance, schedule adherence
• Team attrition, engagement, coaching effectiveness
• Client/Stakeholder satisfaction and escalation closure timeliness

Required Qualifications

• 5–6 years of experience in International Healthcare Claims Operations (payer/TPA/provider revenue cycle claims teams supporting payer processes).
• Minimum 3–4 years in a lead/team supervisor/team lead.
• Strong understanding of claims concepts: adjudication flow, denials, adjustments, benefits/eligibility basics.
• Ability to interpret SOPs, apply judgement, and drive operational discipline.
• Excellent communication (verbal/written), stakeholder management, and people leadership skills.
• Strong working knowledge of MS Office (Excel, PowerPoint); comfort with dashboards and trackers.

Preferred Experience

• Experience with claims platforms/workflows (payer tools), OCR/intake tools, or BPM/queue management systems.
• Exposure to Lean/Six Sigma, Kaizen, or structured CI methods.
• Prior experience working in regulated environments with audit rigor (internal/external).
• Familiarity with provider contracting concepts and network/COB scenarios.

Competencies And Behaviours

• Customer‑first mindset with strong attention to detail
• Bias for action and outcome orientation
• Strong analytical and problem‑solving capability
• Ability to lead through change; coach and motivate teams
• High integrity, compliance orientation, and confidentiality handling

Education

Graduate (Any) – medical, Paramedical, Commerce, Statistics, Mathematics, Economics or Science.

Experience Range

Minimum 5 years in EU/US/Global health insurance claims industry, including hands‑on experience on claims processing of at least 4 years and 3–4 years in managing a team of 12–15 members/associates.

Work Timings

1:00‑10:00 PM IST

Job Location

Bangalore