Job Summary

Serve as a claims health care team lead in a hybrid night shift role overseeing end to end claims adjudication and compliance with HIPAA guidelines for provider and payer operations while mentoring claims analysts improving accuracy and turnaround time and supporting continuous process enhancement for clients in a global MNC environment.

Responsibilities

Lead daily claims adjudication activities for health care clients by monitoring work queues to ensure timely and accurate processing of provider and payer claims in alignment with service level expectations and regulatory norms.
Oversee complex claim reviews by validating eligibility coverage and benefit rules so that payment or denial decisions are consistent with contractual agreements and organizational standards.
Provide detailed guidance to team members on applying claims business rules edits and exceptions so that manual interventions are minimized and auto adjudication outcomes are reliable.




Review claim documentation and supporting clinical or financial records to resolve discrepancies and reduce rework by driving exact root cause identification for each issue.
Coordinate closely with cross functional stakeholders in operations quality compliance and technology to resolve systemic claim defects and to implement sustainable process improvements.
Monitor and analyze daily and weekly performance metrics such as accuracy turnaround time and first pass resolution to identify trends and define targeted improvement actions.
Guide the team on correct interpretation of HIPAA requirements related to privacy security and electronic data exchange so that handling of protected health information remains fully compliant.
Conduct periodic audits of processed claims and provide structured feedback and coaching to team members in order to uplift domain maturity and reduce error rates.
Document operational procedures and create reference guides for complex provider and payer scenarios so that new and existing

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