Claims Adjudication Supervisor

Tata Consultancy Services; Milford (OH); On-site; USD 70,000 - 100,000; Full time

Job summary

Tata Consultancy Services seeks a Claims Adjudication Supervisor to lead daily healthcare payer claims operations and a team of 15–20 professionals in the Cincinnati area. You will ensure accurate, timely outcomes and maintain compliant processes across benefits, eligibility, and COB rules.

Responsibilities include coaching, monitoring productivity & quality, handling escalations, and partnering with Quality, Training, and Client teams to drive improvements while supporting client hours and

Qualifications

• Bachelor's degree preferred, or equivalent combination of education and relevant experience.
• Five or more years of US healthcare payer claims processing or adjudication experience, including at least two years in a team lead or supervisory capacity.
• Working experience with Commercial, Medicare Advantage, Medicaid, managed care, or employer-sponsored health plan claims.
• Strong understanding of end-to-end claims lifecycle, benefits, eligibility, provider data, authorization/referrals, denials, pends, adjustments, COB, and reimbursement concepts.
• Experience with payer claims platforms such as Facets, QNXT, HealthRules, NASCO, Amisys, or equivalent enterprise system.
• Demonstrated ability to manage production commitments while maintaining accuracy, compliance, documentation, and employee engagement.

Responsibilities

• Supervise daily claims adjudication activities, work allocation, queue management, attendance, and operational coverage.
• Lead and coach a team of approximately 15-20 claims professionals, span depending on process complexity and operating model.
• Monitor productivity, quality, turnaround time, backlog, aging, pends, rework, and priority inventory; initiate recovery actions as needed.
• Ensure accurate application of eligibility, benefits, provider data, authorization, referrals, COB, pricing, coding, edits, and payer rules.
• Review and resolve complex or escalated claims, including high-dollar, adjustments, duplicates, provider disputes, reimbursement exceptions, Medicare/Medicaid scenarios within authority.
• Conduct daily huddles, coaching, performance discussions, quality feedback, and refresher interventions.
• Partner with Quality, Training, Workforce Management, SMEs, Technology, and Client teams to improve outcomes and readiness.
• Lead root cause analysis and corrective/preventive actions for recurring errors and SLA misses.
• Maintain complete operational records, claim notes, audit evidence, issue logs, and status reporting.
• Support change implementation, new benefits or policy updates, system releases, ramping activities.
• Promote a culture of ethics, inclusion, accountability, data privacy, and continuous improvement.

Skills

Team leadership

Coaching

Communication

Analytical problem-solving

Stakeholder management

Education

Bachelor's degree or equivalent

Tools

Facets

QNXT

HealthRules

NASCO

Amisys

Job description

The Claims Adjudication Supervisor leads day-to-day healthcare payer claims operations and a team of Claims Processors, Claims Examiners, and Senior Associates. The role is accountable for accurate and timely claim outcomes, disciplined inventory management, associate coaching, compliance, and achievement of client-defined productivity, quality, turnaround-time, and service-level expectations.

Key Responsibilities

• Supervise daily claims adjudication activities, work allocation, queue management, attendance, and operational coverage.
• Lead and coach a team of approximately 15-20 claims professionals, with the final span determined by process complexity and the approved operating model.
• Monitor productivity, quality, turnaround time, backlog, aging, pends, rework, and priority inventory; initiate timely recovery actions where required.
• Ensure accurate application of member eligibility, plan benefits, provider information, authorization and referral rules, coordination of benefits, pricing, coding logic, edits, and payer-specific procedures.
• Review and facilitate resolution of complex or escalated claims, including high-dollar claims, adjustments, duplicate claims, provider disputes, reimbursement exceptions, and Medicare or Medicaid scenarios within defined authority.
• Conduct daily huddles, one-to-one coaching, performance discussions, quality feedback, and refresher interventions.
• Partner with Quality, Training, Workforce Management, SMEs, Technology, and Client teams to improve outcomes and sustain operational readiness.
• Lead root cause analysis and corrective or preventive action plans for recurring errors, SLA misses, and control gaps.
• Maintain complete operational records, claim notes, audit evidence, issue logs, and status reporting.
• Support change implementation, new benefit or policy updates, system releases, and transition or ramp activities.
• Promote a culture of ethics, inclusion, accountability, data privacy, and continuous improvement.

Required Qualifications

• Bachelor's degree preferred, or an equivalent combination of education and relevant experience.
• Five or more years of US healthcare payer claims processing or adjudication experience, including at least two years in a team lead or supervisory capacity.
• Working experience with Commercial, Medicare Advantage, Medicaid, managed care, or employer-sponsored health plan claims.
• Strong understanding of the end-to-end claims lifecycle, benefits, eligibility, provider data, authorization and referrals, denials, pends, adjustments, coordination of benefits, and reimbursement concepts.
• Working knowledge of ICD-10, CPT, and HCPCS code sets and their use in claims operations; this role does not require clinical coding unless specified by the account.
• Experience using a payer claims platform such as Facets, QNXT, HealthRules, NASCO, Amisys, or an equivalent enterprise claims system.
• Demonstrated ability to manage production commitments while maintaining accuracy, compliance, documentation, and employee engagement.
• Strong written and verbal communication, analytical problem-solving, stakeholder management, and coaching skills.
• Ability to work from the Cincinnati area and support client-defined business hours, including schedule flexibility during transitions or peak periods.