Claims Adjudication Supervisor

Tata Consultancy Services; Milford (OH); Sur place; USD 65 000 - 85 000; Plein temps

Résumé du poste

Tata Consultancy Services Limited seeks a Claims Adjudication Supervisor to lead a team of 15–20 claims professionals in Cincinnati, overseeing daily adjudication activities and ensuring accurate, timely outcomes. You will coach staff, manage queues, and monitor productivity and quality to meet client SLAs.

The role requires a strong understanding of the US healthcare payer claims lifecycle, eligibility, and processing rules, with experience on enterprise claims platforms.

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; does not require clinical coding unless specified by the account.
• Experience using payer claims platforms such as Facets, QNXT, HealthRules, NASCO, Amisys, or 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.

Responsabilités

• 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.

Connaissances

Team leadership

Coaching

Analytical problem solving

Stakeholder management

Communication skills

Formation

Bachelor's degree preferred

Outils

Enterprise claims system

Description du poste

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.