Claims Supervisor

SYSGEN RPO; Makati; On-site; PHP 3,776,000 - 5,664,000; Full time

Job summary

SYSGEN RPO seeks a Claims Adjudication Supervisor to lead end-to-end medical claims adjudication for US health plan operations, ensuring accuracy, KPI adherence, and excellent client communication.

You will design training curricula, oversee QA processes, and manage performance with dashboards, certifications, and strict SLA monitoring for 35–50 FTEs in a fast-paced, client-facing setting.

Qualifications

• 5+ years in U.S. healthcare claims adjudication.
• 2-3 years leading teams of 35-50 FTEs.
• Deep knowledge of medical terminology and coding (ICD, CPT, HCPCS).
• Excellent verbal and written communication with clients.
• Experience creating training programs and certification paths.
• Experience managing KPIs and SLAs in BPO/healthcare operations.
• Data-driven decision making with strong analytical skills.
• Ability to work in a fast-paced environment with multiple priorities.
• Experience supporting U.S. health plans or TPAs.
• Exposure to AI-assisted adjudication tools.

Responsibilities

• Manage daily adjudication operations ensuring accuracy, productivity, and SLA attainment.
• Oversee team performance through dashboards, scorecards, and KPI monitoring.
• Lead daily/weekly huddles, coaching sessions, and escalations.
• Implement an Attendance and Performance Early Warning system to prevent SLA risks.
• Drive continuous improvement initiatives to reduce errors, processing delays, and rework.
• Create structured training programs, curriculum, and learning modules for all levels.
• Maintain training documents, guides, SOPs, and reference materials.
• Develop quizzes, evaluations, certification exams, and progression criteria for adjudicators.
• Manage bootcamps, uptraining, and graduation processes.
• Conduct refreshers, new-hire training, and remediation programs.

Skills

Leadership

Communication

Data-driven

Analytical

Problem solving

Team leadership

KPI management

U.S. healthcare claims

AI tools

Job description

The Claims Adjudication Supervisor is responsible for leading, developing, and managing the end-to-end medical claims adjudication function for US health plan operations. This role ensures high-quality claims processing, operational accuracy, adherence to KPIs and SLAs, and exceptional client communication. The Supervisor will be accountable for building and executing comprehensive training programs (curriculum, modules, assessments, certifications), overseeing quality assurance processes, driving team accountability through structured performance management, and providing timely, consistent business reporting to both internal leadership and external clients. This is a highly visible, client-facing role requiring strong communication skills, deep knowledge of U.S. healthcare claims adjudication, and the ability to lead teams in a fast-paced environment.

Key responsibilities

• Manage daily adjudication operations ensuring accuracy, productivity, and SLA attainment.
• Oversee team performance through dashboards, scorecards, and KPI monitoring.
• Lead daily/weekly huddles, coaching sessions, and escalations.
• Implement an Attendance and Performance Early Warning system to prevent SLA risks.
• Drive continuous improvement initiatives to reduce errors, processing delays, and rework.
• Create structured training programs, curriculum, and learning modules for all levels.
• Maintain training documents, guides, SOPs, and reference materials.
• Develop quizzes, evaluations, certification exams, and progression criteria for adjudicators.
• Manage bootcamps, uptraining, and graduation processes.
• Conduct refreshers, new-hire training, and remediation programs.

About you

• 5+ years of experience in U.S. healthcare claims adjudication, with deep end-to-end process knowledge.
• 2-3 years of leadership experience managing claims adjudication teams (35-50 FTEs).
• Strong understanding of medical terminology, coding (ICD, CPT, HCPCS), plan structures, and benefit rules.
• Excellent verbal and written communication skills; highly responsive and professional with clients.
• Demonstrated ability to create training programs, curriculum, modules, and certification paths.
• Experience managing KPIs and SLAs in a BPO or healthcare operations environment.
• Strong analytical and problem-solving abilities; comfortable with data-driven decision-making.
• Ability to work in a fast-paced environment and manage multiple priorities.
• Experience supporting U.S. health plans or TPAs.
• Exposure to AI-assisted adjudication tools or digital transformation initiatives.