Job Summary

This hybrid role focuses on transactional leadership in health care claims operations for both provider and payer functions ensuring precise HIPAA compliant claims adjudication during night shifts. The team lead guides a small claims team resolves complex claim scenarios improves adjudication quality and supports service goals for global health plan clients.

Responsibilities

Guide a team of claims analysts in day to day claims adjudication activities to ensure timely and accurate processing of health care claims during night shifts in a hybrid work environment.
Oversee adjudication of complex provider and payer claims while applying HIPAA regulations and benefit plan rules to minimize financial leakage and processing errors.
Drive continuous improvement in end to end claims workflows by analyzing trends in rework denials and customer escalations and by implementing targeted process refinements.




Monitor individual and team performance metrics such as turnaround time financial accuracy procedural accuracy and inventory aging while taking corrective actions when thresholds are at risk.
Coordinate closely with quality audit and training partners to address recurring defects in claims adjudication and to update job aids based on policy or regulatory changes.
Provide expert guidance on provider contracting reimbursement methodologies coordination of advantages and subrogation scenarios to ensure consistent application of payer business rules.
Escalate systemic issues in claims platforms or upstream enrollment and billing processes and collaborate with technology and operations stakeholders to design sustainable fixes.
Conduct regular night shift huddles to communicate daily priorities policy updates and client expectations fostering transparent communication across the claims team.
Respond to claim inquiries from internal partners and client representatives by performing root cause analysis and presenting clear data backed resolutions that enhance stakeholder

📌 Returnship - TL-Claims HC (Pune)
🏢 Cognizant
📍 Pune