HRO : Claims Processing : Adjudication Specialist : Max 8 LPA : Apply

Outpace Consulting Services; Mumbai; On-site; INR 600,000 - 900,000; Full time

Job summary

Outpace Consulting Services in Mumbai is seeking a Claims Processing & Adjudication Specialist to review, validate, process and settle employee benefit claims and reimbursements in line with policies and SLAs.

You will collaborate with global stakeholders, ensure policy alignment, and drive accuracy across the claims lifecycle using HR systems and ticketing tools. This role demands attention to detail and proactive process improvement.

Qualifications

• Minimum 5 years in Claims Processing & Adjudication.
• Experience handling employee reimbursements, benefits claims, and salary advance processes.
• Experience supporting international employee populations and global stakeholders.
• Any Graduate.

Responsibilities

• Process and adjudicate employee benefit claims accurately and within defined timelines.
• Review, verify, and validate claim documentation as per policies and guidelines.
• Handle various claim types including Gym, Vaccination, Wellbeing, School, Salary Advance, and other reimbursements.
• Identify discrepancies and ensure timely resolution.
• Maintain high levels of accuracy and compliance throughout the claims lifecycle.
• Collaborate with global stakeholders to align claims policies and standards.
• Partner with internal HR teams, employees, vendors, and third parties.
• Provide timely communication and support regarding claim status and resolutions.
• Ensure adherence to SLAs and monitor KPI metrics.
• Support operational reporting and performance reviews.
• Ensure compliance with policies, audit requirements, and regional regulations.
• Maintain complete and accurate claims records.
• Identify process gaps and drive improvements.
• Participate in process improvement initiatives and operational excellence.

Skills

Claims processing & adjudication

Employee reimbursements

Benefits claims

Salary advance processes

International/Global stakeholders

Education

Any Graduate

Tools

HRIS systems

Ticketing systems

Claims processing software

Job description

Hi,

We are hiring for one of India's leading IT & consulting organizations for the position of Claims Processing & Adjudication Specialist.

Summary:

Claims Processing & Adjudication Specialist is responsible for reviewing, validating, processing, and settling employee benefit claims and corporate reimbursement requests according to company policies, eligibility criteria, and Service Level Agreements.

Key Skills:

• Minimum 5 years of experience in Claims Processing & Adjudication.
• Experience handling employee reimbursements, benefits claims, and salary advance processes.
• Experience supporting international employee populations and global stakeholders.
• Any Graduate.

Key Responsibilities:

1. Claims Processing & Adjudication

• Process and adjudicate employee benefit claims accurately and within defined timelines.
• Review, verify, and validate claim documentation as per organizational policies and guidelines.
• Handle various claim types, including:
  • Gym Reimbursement Claims
  • Vaccination Claims
  • Wellbeing Benefits Claims
  • School Reimbursement Claims
  • Salary Advance Claims
  • Other employee benefit-related reimbursements
• Identify discrepancies and exceptions in claims and ensure timely resolution.
• Maintain high levels of accuracy and compliance throughout the claims lifecycle.

2. Stakeholder Management

• Collaborate with global stakeholders to ensure alignment with claims policies and standards.
• Partner with internal HR teams, employees, vendors, and third-party service providers.
• Provide timely communication and support regarding claim status and resolutions.

3. SLA & KPI Management

• Ensure adherence to defined Service Level Agreements (SLAs).
• Monitor claims turnaround times and quality metrics.
• Consistently meet or exceed established Key Performance Indicators (KPIs).
• Support operational reporting and performance reviews.

4. Compliance & Continuous Improvement

• Ensure compliance with company policies, audit requirements, and regional regulations.
• Maintain complete and accurate claims records.
• Identify process gaps and recommend improvements to enhance efficiency and employee experience.
• Participate in process improvement initiatives and operational excellence programs.

5. Systems & Tools

• Work with HR and benefits administration systems for claims processing.
• Utilize ticketing and workflow management tools to monitor and manage claim activities.
• Maintain accurate documentation and tracking of all transactions.