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 About Accenture Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com What would you do?

The Team

Lead – Appeals & Grievance (A&G;) is responsible for overseeing the daily operations of the A&G; 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 A&G; processors/analysts Assign workloads and monitor daily productivity and turnaround times (TAT) Conduct regular team huddles, feedback sessions, and performance reviews Provide coaching and training to improve team skills and knowledge Operations & Case Oversight: Oversee the end-to-end appeals and grievance process Review complex or escalated cases and provide resolution guidance Ensure accurate documentation and proper case handling Monitor case queues and ensure adherence to SLAs Compliance & Quality Assurance: Ensure all cases meet regulatory requirements (CMS, HIPAA, and internal policies)



Conduct quality audits and provide actionable feedback Identify risks, gaps, and compliance issues, and implement corrective actions Stakeholder 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 management Identify process improvement opportunities and drive efficiency initiatives Support implementation of current policies, systems, and workflows Core Competencies: Strong leadership and team management skills Excellent analytical and problem-solving abilities In-depth knowledge of appeals and grievance processes Understanding of healthcare regulations (CMS, HIPAA) Effective communication and stakeholder management Ability to handle escalations and make decisions under pressure Strong 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 strong client relationship Knowledge of Medicare/Medicaid guidelines Familiarity with medical terminology and claims processing Experience 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

📌 Delivery Operations Senior Analyst (Navi Mumbai)
🏢 Accenture in India
📍 Navi Mumbai