Healthcare Claims Adjudication Lead & Training Architect

Sysgen RPO, Inc.; Makati; On-site; PHP 1,200,000 - 1,800,000; Full time

Job summary

Sysgen RPO, Inc. is seeking a Claims Adjudication Supervisor to lead the end-to-end medical claims adjudication function for our US health plan operations from Metro Manila. The role emphasizes quality, KPI-driven performance, and client communication.

You will build training programs, oversee QA, manage performance, and provide timely business reporting to leadership and clients in a fast-paced environment.

Qualifications

• 5+ years in U.S. healthcare claims adjudication.
• 2–3 years leading adjudication teams (35–50 FTEs).
• Strong knowledge of medical terminology, ICD, CPT, HCPCS, plan rules.
• Excellent verbal and written communication with clients.
• Experience creating training curricula and certification paths.

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

Healthcare claims adjudication

Leadership

Communication

Training program design

KPIs & SLAs management

Data analysis

Fast-paced environment

U.S. health plans/TPAs experience

AI-assisted adjudication tools

Job description

Sysgen RPO, Inc. is seeking a Claims Adjudication Supervisor to lead the end-to-end medical claims adjudication function for our US health plan operations from Metro Manila. The role emphasizes quality, KPI-driven performance, and client communication.

You will build training programs, oversee QA, manage performance, and provide timely business reporting to leadership and clients in a fast-paced environment.