Team Manager (US Healthcare Insurance)

Sutherland; Ernakulam; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

Sutherland in India seeks an Associate Manager STD Claims to lead a ShortTerm Disability claims team in a voice or blended environment. You will oversee end-to-end adjudication, ensure compliant interactions, and drive KPI delivery while mentoring analysts.

The role requires 5+ years of experience in US health insurance claims, strong leadership, regulatory knowledge (ERISA, HIPAA), and proficiency with claims platforms and MS Office.

Qualifications

• 5+ years leading voice or blended claims teams in US health or disability insurance.
• Strong understanding of STD/LTD claims adjudication and policy terms.
• Experience with ERISA/HIPAA compliance and regulatory requirements.
• Leadership experience with performance management and mentoring.

Responsibilities

• Lead and mentor STD Claims Analysts in voice and blended workflows.
• Oversee inbound/outbound claimant calls and employer communications.
• Monitor end-to-end STD claim processing and timely adjudication.
• Ensure quality, compliance, and adherence to ERISA/HIPAA guidelines.
• Track KPIs (AHT, call quality, SLA, TAT, productivity, accuracy) and drive improvements.
• Manage staffing, queues, and backlog to prevent aging of claims.
• Coordinate with medical review, HR, legal, and client representatives on escalations.
• Provide training on call handling, adjudication, and documentation standards.
• Identify workflow gaps and implement efficiency improvements.
• Prepare dashboards and share insights with leadership.
• Deliver high-quality claimant experiences with timely updates.

Skills

Team Leadership

Performance Management

Regulatory Knowledge

Analytical Skills

Communication Skills

Claims Adjudication

Voice Process

Process Improvement

MS Office

Tools

Claims management systems

MS Office

Job description

The Associate Manager STD Claims will lead and manage a ShortTerm Disability (STD) claims team operating in a voice or blended (voice + nonvoice) environment. This role ensures accurate claim adjudication, highquality customer interactions, compliance with regulatory standards, and consistent delivery of service KPIs. The position requires strong people leadership, operational oversight, and the ability to manage both callbased and backoffice claim functions.

Key Responsibilities

• Team Leadership Lead, coach, and mentor STD Claims Analysts handling both voice and blended workflows; conduct performance reviews and support career development.
• Voice/Blended Operations Oversee inbound/outbound claimant calls, employer communication, and documentation accuracy while ensuring empathetic and compliant interactions.
• Claims Oversight — Monitor endtoend STD claim processing, ensuring timely adjudication aligned with policy terms, medical documentation, and regulatory requirements.
• Quality & Compliance — Ensure all voice and nonvoice interactions meet quality benchmarks, ERISA guidelines, HIPAA standards, and internal audit requirements.
• Performance Management — Track KPIs including AHT, call quality, SLA, TAT, productivity, and accuracy; implement action plans for improvement.
• Workflow & Queue Management — Manage staffing, schedule adherence, call queues, and claim inventory to prevent aging and backlog.
• Stakeholder Collaboration — Coordinate with medical review teams, HR partners, employers, legal, and client representatives to resolve escalations.
• Training & Coaching — Conduct training on call handling, claims adjudication, documentation standards, and customer empathy.
• Process Improvement — Identify gaps in voice/blended workflows and implement solutions to enhance efficiency and customer experience.
• Reporting & Insights — Prepare weekly/monthly dashboards, analyze trends, and present operational insights to leadership.
• Customer Experience — Ensure highquality claimant interactions, timely updates, and empathetic communication throughout the claims lifecycle.

Qualifications

Our most successful candidates will have:

• 5+ years of experience handling voice and blended process team for US Insurance or health insurance claims
• Claims Expertise — 3–5+ years of experience in STD, LTD, disability, or health insurance claims; strong understanding of claim adjudication.
• Voice Process Experience — Prior experience managing voice or blended operations in insurance, healthcare, or financial services.
• Regulatory Knowledge — Familiarity with ERISA, HIPAA, state disability laws, and insurance compliance standards.
• Leadership Skills — Proven ability to lead teams, manage performance, and drive operational excellence.
• Analytical Skills — Strong decisionmaking ability with experience reviewing medical records and policy language.
• Communication Skills — Excellent verbal and written communication for claimant calls, employer interactions, and stakeholder coordination.
• Process Orientation — Strong focus on accuracy, documentation, and compliance.
• Tools & Systems — Experience with claims management platforms, callhandling systems, and MS Office.