Director, Claims Adjudication & Operations

Tata Consultancy Services

Milford (OH)

On-site

USD 120,000 - 180,000

Full time

3 days ago

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Job summary

Tata Consultancy Services seeks an experienced Claims Adjudication Manager to lead end-to-end operations for US healthcare payer functions. You will oversee frontline leaders, manage client governance, and drive quality, risk management, and continuous improvement across multiple teams.

This role requires 8+ years in payer operations with claims adjudication and strong leadership, governance, and stakeholder management capabilities.

Qualifications

Bachelor's degree required; advanced degree preferred.
8+ years in US healthcare payer ops with claims adjudication and leadership.
Experience leading multi-team healthcare operations and frontline leaders.
Deep knowledge of claims, benefits, eligibility, and provider reimbursement.
Experience with enterprise payer platforms (Facets, QNXT, HealthRules, NASCO, Amisys).
Strong client relationship management and executive communication.
Willingness to work from the Cincinnati area and support client hours.

Responsibilities

Lead adjudication delivery across teams, queues, products, or lines of business.
Provide direction to Supervisors, Team Leads, SMEs, and other operational roles.
Own delivery against SLAs, KPIs, quality standards, and contractual commitments.
Govern inventory, backlog, aging, pends, rework, escalations, and service recovery.
Ensure readiness for policy changes, system releases, migrations, and new scope transitions.