Lead-Claims Adjudication-Thryve Digital Health LLP

Job Description

Role: Team Lead -Claims Adjudication
Position: Non-Technical
Skill: Claims Adjudication (US Healthcare Process)
Shift: 11:00 AM - 8:00 PM IST
Work Location: Chennai
Work Mode: Onsite (all 5 days work from office)
Venue: SEZ, Ramanujan IT City, 6th Floor Cambridge Tower, SH 49A, Tharamani, Chennai, Tamil Nadu 600113, India

Role Summary:

This job takes the lead in handling a team of 25-30 team members providing complex claims adjudication services typically as part of Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies. Claims Adjudicators provide general support to maintain TAT, meet SLAs, performance and quality levels required by their customers. Mentor and motivate team members.

Essential Responsibilities

• Adhere to organizational policies
• Handle a team of 20-25 associates
• Deliver SLAs and have close traction on Teams performance. Monitor & have governance on potential risks
• Drive Innovation within team
• Process claims with the team to understand the updates and business protocols
• Attrition & retention management talent retention
• Succession planning & EWS forecast
• Learning management / Stay compliant with L&D courses (Self Vs. Team)
• Create, Maintain & share dashboards with leadership
• Drive employee engagement & team building activities

The experience we are looking to add to our team require:

• Greater than 8 years of experience in US Healthcare
• Bachelors or Masters degree in any discipline
• Good verbal and written skills
• Good analytical and interpersonal skills
• Exceptional people management

Good to have:

• AHM or any equivalent certification
• Acquaintance to Six Sigma methodology & tools
• Business acumen on Adjustments and Offset/Recovery

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Keyskills:   Claims Adjudication Team Handling Team Leadership