Senior Claims Adjudication & Operations Leader

Tata Consultancy Services Limited; Milford (OH); On-site; USD 90,000 - 130,000; Full time

Job summary

Tata Consultancy Services Limited in Milford, Ohio, is looking for a Claims Adjudication Manager to lead end-to-end operations in US healthcare payer environments.

You will guide frontline supervisors, manage SLAs, and drive quality, compliance, and continuous improvement across claims processing, with cross-functional partners.

This role emphasizes governance, risk management, and financial discipline, with exposure to client reviews and transformation initiatives.

Qualifications

• Bachelor's degree required; an advanced degree is preferred.
• Eight or more years of US healthcare payer operations experience, including substantial claims adjudication experience and at least five years in people and delivery leadership roles.
• Demonstrated experience leading multi-team healthcare operations and frontline leaders; the final span will be aligned to account size and complexity.
• Deep understanding of professional and institutional claims, benefits, eligibility, authorization, provider reimbursement, coordination of benefits, adjustments, denials, pends, appeals or payment-integrity touchpoints.
• Experience with Commercial, Medicare Advantage, Medicaid, managed care, or employer-sponsored plan operations.
• Experience with an enterprise payer claims platform such as Facets, QNXT, HealthRules, NASCO, Amisys, or an equivalent system.
• Strong client relationship management, executive communication, operational governance, financial acumen, risk management, and data-driven decision-making skills.
• Ability to work from the Cincinnati area and support client-defined business hours, including schedule flexibility during transitions, peak periods, or critical incidents.

Responsibilities

• Lead claims adjudication delivery across multiple teams, queues, products, or lines of business, with the final organization size determined by the approved account model.
• Provide direction to Supervisors, Team Leads, SMEs, Quality Analysts, Trainers, and other operational support roles.
• Own delivery against client-defined SLAs, KPIs, quality standards, turnaround times, contractual controls, and operational commitments.
• Establish disciplined governance for inventory, backlog, aging, pends, rework, high-dollar claims, escalations, and service recovery.
• Ensure operational readiness for benefit changes, policy updates, system releases, seasonal volume, migrations, and new scope transitions.

Skills

Leadership

Claims adjudication

Payer operations

HIPAA compliance

SLAs & KPIs

Data-driven decisions

Executive communication

Education

Bachelor's degree

Tools

Facets

QNXT

HealthRules

NASCO

Amisys

Job description

Tata Consultancy Services Limited in Milford, Ohio, is looking for a Claims Adjudication Manager to lead end-to-end operations in US healthcare payer environments.

You will guide frontline supervisors, manage SLAs, and drive quality, compliance, and continuous improvement across claims processing, with cross-functional partners.

This role emphasizes governance, risk management, and financial discipline, with exposure to client reviews and transformation initiatives.