US Health insurance and claims

Claims Adjudication & Escalation Management

• Manage accurate adjudication of US medical claims as per defined guidelines and policies
• Handle escalations, resolve issues, and ensure proper documentation
• Ensure compliance with insurance policies, procedures, and regulatory standards 

Team Management & Leadership

• Provide coaching and feedback to team members to improve performance
• Support new hires and accelerate their learning curve
• Conduct regular performance reviews and manage team productivity
• Manage staffing to meet operational requirements and shrinkage targets
• Drive initiatives to reduce attrition and improve engagement 

Performance & Quality Management

• Monitor transactions regularly and implement corrective actions
• Ensure achievement of all SLA/KPIs (quality, productivity, turnaround time)
• Identify opportunities for process improvement and implement enhancements
• Maintain high standards of work quality and accuracy 

Stakeholder & Client Interaction

• Communicate proactively with internal and external stakeholders
• Build and maintain strong relationships with clients and business partners
• Handle client interactions at supervisory level when required 

Reporting & Compliance

• Ensure timely and accurate reporting of internal and external metrics
• Support audits by collecting and providing required data
• Ensure adherence to internal policies, external regulations, and information security standards 

 

Additional Requirements

• Willingness to work in night shift and WFO
• Ensure consistent achievement of KPIs
• Proactive communication on daily operational issues
• Continuous focus on quality, productivity, and customer satisfaction