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 a
Claims Supervisor
, you will be responsible for supervising and coordinating
end‑to‑end healthcare operations
across
claims processing, claim adjustments, eligibility maintenance, member onboarding, and group setup
. You will lead frontline teams to ensure
accurate member and group configuration, timely claims adjudication, compliant adjustments, and seamless downstream processing
, while meeting
SLA, quality, and customer experience targets
.
This role plays a critical role in ensuring
upstream accuracy (eligibility, onboarding, group setup)
and
downstream 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 to
SOPs, 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 in
member eligibility, group setup, and benefit configuration
to prevent claim errors and rework.
Monitor claims and adjustments for
correct application of benefits, pricing, and policy rules
.
Conduct regular
quality checks, audits, and case reviews
.
Identify error trends, perform root‑cause analysis, and drive corrective actions.
Ensure compliance with
healthcare regulations, audit requirements, data privacy standards (HIPAA/GDPR as applicable), and internal controls
.
3. People Leadership
Lead and support a team of
Claims Processors, Eligibility Analysts, and Onboarding Specialists
(typically 10–20 FTE).
Set clear performance expectations and provide ongoing coaching and feedback.
Support
new hire onboarding, training, and cross‑skilling
across processes.
Conduct regular performance discussions and contribute to formal reviews.
Build a culture of
accountability, collaboration, quality, and customer focus
.
4. Performance Management & Reporting
Track daily and weekly performance against
productivity, SLA, TAT, quality, and adjustment metrics
.
Prepare and share
operational 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 improve
process efficiency, first‑time‑right outcomes, and member experience
.
Participate in
process improvement, standardisation, and automation initiatives
.
Support implementation of
new products, benefit changes, group renewals, and system enhancements
.
Act as a change champion, ensuring smooth adoption within the team.
6. Stakeholder Collaboration
Work closely with
Quality, Training, Claims, Enrollment, Configuration, Technology, and Onshore Teams
.
Coordinate issue resolution related to
eligibility errors, group setup defects, and claim reprocessing
.
Provide timely operational updates, risks, and dependency insights to leadership.
Your Profile
Experience
10 years
of experience in
healthcare operations
, with hands‑on exposure to:
Claims processing and adjustments
Eligibility and enrollment
Member onboarding
Group setup / benefit configuration
1–3 years
in a
Team Lead or Supervisory role
.
Experience working in
high‑volume, SLA‑driven healthcare environments
.
Strong understanding of
end‑to‑end healthcare operations and interdependencies
.
Skills & Capabilities
Solid understanding of
claims adjudication, benefit interpretation, eligibility rules, and adjustments
.
Working knowledge of
group setup, benefit plans, and configuration accuracy
.
Strong analytical and problem‑solving skills.
Proficiency in
Excel 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.
