Job Description
Claims Supervisor – Claims, Adjustments, Eligibility, Member Onboarding Group Setup
Location: CHSI, Bengaluru, India
Reporting to: Senior Supervisor / Manager Operations
Role Level: Supervisor
Experience Required: 10 years (Healthcare Operations)
Role Purpose
As aClaims Supervisor, you will be responsible for supervising and coordinatingend‑to‑end healthcare operations acrossclaims processing, claim adjustments, eligibility maintenance, member onboarding, and group setup. You will lead frontline teams to ensureaccurate member and group configuration, timely claims adjudication, compliant adjustments, and seamless downstream processing, while meetingSLA, quality, and customer experience targets.
This role plays a critical role in ensuringupstream accuracy (eligibility, onboarding, group setup) anddownstream effectiveness (claims and adjustments), minimizing rework, leakage, and member/provider dissatisfaction in a regulated healthcare environment.
Key Responsibilities
1. Operational Supervision
- Supervise daily operations across:
- Claims processing and adjudication
- Claim adjustments and reprocessing
- Eligibility maintenance and updates
- Member onboarding and coverage activation
- Group setup, renewals, and benefit configuration
- Allocate work, monitor queues, volumes, and ageing across processes.
- Ensure adherence toSOPs, business rules, benefit structures, and SLAs.
- Proactively identify and address backlogs, errors, and operational risks.
- Coordinate dependencies across upstream and downstream workflows.
2. Quality, Accuracy Compliance
- Ensure high accuracy inmember eligibility, group setup, and benefit configuration to prevent claim errors and rework.
- Monitor claims and adjustments forcorrect application of benefits, pricing, and policy rules.
- Conduct regularquality checks, audits, and case reviews.
- Identify error trends, perform root‑cause analysis, and drive corrective actions.
- Ensure compliance withhealthcare regulations, audit requirements, data privacy standards (HIPAA/GDPR as applicable), and internal controls.
3. People Leadership
- Lead and support a team ofClaims Processors, Eligibility Analysts, and Onboarding Specialists (typically 10–20 FTE).
- Set clear performance expectations and provide ongoing coaching and feedback.
- Supportnew hire onboarding, training, and cross‑skilling across processes.
- Conduct regular performance discussions and contribute to formal reviews.
- Build a culture ofaccountability, collaboration, quality, and customer focus.
4. Performance Management Reporting
- Track daily and weekly performance againstproductivity, SLA, TAT, quality, and adjustment metrics.
- Prepare and shareoperational dashboards and reports with Senior Supervisors / Managers.
- Monitor rework, adjustment volumes, and upstream error leakage.
- Use data to highlight risks, trends, and improvement opportunities.
- Drive focused action plans to close performance gaps.
5. Process Improvement Change Support
- Identify opportunities to improveprocess efficiency, first‑time‑right outcomes, and member experience.
- Participate inprocess improvement, standardisation, and automation initiatives.
- Support implementation ofnew products, benefit changes, group renewals, and system enhancements.
- Act as a change champion, ensuring smooth adoption within the team.
6. Stakeholder Collaboration
- Work closely withQuality, Training, Claims, Enrollment, Configuration, Technology, and Onshore Teams.
- Coordinate issue resolution related toeligibility errors, group setup defects, and claim reprocessing.
- Provide timely operational updates, risks, and dependency insights to leadership.
Your Profile
Experience
- 10 years of experience inhealthcare operations, with hands‑on exposure to:
- Claims processing and adjustments
- Eligibility and enrollment
- Member onboarding
- Group setup / benefit configuration
- 1–3 years in aTeam Lead or Supervisory role.
- Experience working inhigh‑volume, SLA‑driven healthcare environments.
- Strong understanding ofend‑to‑end healthcare operations and interdependencies.
Skills Capabilities
- Solid understanding ofclaims adjudication, benefit interpretation, eligibility rules, and adjustments.
- Working knowledge ofgroup setup, benefit plans, and configuration accuracy.
- Strong analytical and problem‑solving skills.
- Proficiency inExcel and operational reporting tools.
- Ability to manage multiple workflows and competing priorities.
- Clear and effective communication skills.
- Hands‑on experience with healthcare systems and workflow tools.
Behavioural Attributes
- Results‑oriented with strong ownership and attention to detail.
- Quality‑focused with a compliance mindset.
- Calm under pressure and effective in operational issue resolution.
- Collaborative, approachable, and supportive leader.
- Adaptable and open to change with a continuous improvement mindset.
- High integrity and customer‑centric approach.
Key Competencies
- Frontline people leadership
- Operational execution discipline
- Quality and compliance focus
- Cross‑process coordination
- Data‑driven performance management
- Problem solving root‑cause analysis
- Stakeholder collaboration
- Change adaptability
About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
