About The Role
Skill required: Claims Appeals - Claims Administration

Designation: Delivery Operations Senior Analyst

Qualifications:BBA/BCom/BMS

Years of Experience:5 to 8 years

Language - Ability:English(Domestic) - Proficient

- Technology and Operations services, and Accenture Song” all powered by the world's largest network of Advanced Technology and Intelligent Operations centers.

What would you do
The Team Lead – Appeals Grievance (AG) is responsible for overseeing the daily operations of the AG team, ensuring timely and accurate resolution of member and provider appeals and complaints. This role focuses on driving team performance, maintaining regulatory compliance (e.g., CMS, HIPAA), improving quality, and supporting team development while ensuring high customer satisfaction.Team Management Leadership:Lead, mentor, and support a team of AG processors/analystsAssign workloads and monitor daily productivity and turnaround times (TAT)Conduct regular team huddles, feedback sessions, and performance reviewsProvide coaching and training to improve team skills and knowledgeOperations Case Oversight:Oversee the end-to-end appeals and grievance processReview complex or escalated cases and provide resolution guidanceEnsure accurate documentation and proper case handlingMonitor case queues and ensure adherence to SLAsCompliance Quality Assurance:Ensure all cases meet regulatory requirements (CMS, HIPAA, and internal policies)Conduct quality audits and provide actionable feedbackIdentify risks, gaps, and compliance issues, and implement corrective actionsStakeholder Coordination:Collaborate with cross-functional teams (claims, enrollment, billing, providers)Act as a point of contact for escalations from members or providers.



Communicate updates and resolutions clearly to internal and external stakeholders. Reporting Process Improvement:Track and analyze team performance metrics (productivity, quality, TAT)Prepare and present reports to managementIdentify process improvement opportunities and drive efficiency initiativesSupport implementation of new policies, systems, and workflowsCore Competencies:Strong leadership and team management skillsExcellent analytical and problem-solving abilitiesIn-depth knowledge of appeals and grievance processesUnderstanding of healthcare regulations (CMS, HIPAA)Effective communication and stakeholder managementAbility to handle escalations and make decisions under pressureStrong organizational and time management skills

What are we looking for

- Adaptable and flexible
- Ability to perform under pressure
- Problem-solving skills
- Detail orientation
- Ability to establish solid client relationshipKnowledge of Medicare/Medicaid guidelinesFamiliarity with medical terminology and claims processingExperience with quality audits and reporting tools

Roles and Responsibilities:
- In this role you are required to do analysis and solving of increasingly complex problems
- Your day to day interactions are with peers within Accenture
- You are likely to have some interaction with clients and/or Accenture management
- You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments
- Decisions that are made by you impact your own work and may impact the work of others
- In this role you would be an individual contributor and/or oversee a small work effort and/or team
- Please note that this role require you to work in US Shift time. No rotational shifts and Morning shifts

QualificationBBA,BCom,BMS

📌 Delivery Operations Senior Analyst (Maharashtra)
🏢 Accenture
📍 Maharashtra