Job Description
Claims Supervisor – Claims, Adjustments, Eligibility, Member Onboarding & Group Setup
Location: CHSI, Bengaluru, India
Reporting to: Senior Supervisor / Manager Operations
Role Level: Supervisor
Experience Required: 10 years (Healthcare Operations)
Role Purpose
As a Claims Supervisor, you will be responsible for supervising and coordinating end‑to‑end healthcare operations across claims processing, claim adjustments, eligibility maintenance, member onboarding, and group setup. You will lead frontline teams to ensure accurate member and group configuration, timely claims adjudication, compliant adjustments, and seamless downstream processing, while meeting SLA, quality, and customer experience targets.
This role plays a critical role in ensuring upstream accuracy (eligibility, onboarding, group setup) and downstream effectiveness (claims and adjustments), minimizing rework, leakage, and member/provider dissatisfaction in a regulated healthcare environment.
Key Responsibilities
1. Operational Supervision
Supervise daily operations across:




Claims processing and adjudication
Claim adjustments and reprocessing
Eligibility maintenance and updates
Member onboarding and coverage activation
Group setup, renewals, and benefit configuration
Allocate work, monitor queues, volumes, and ageing across processes.
Ensure adherence to SOPs, business rules, benefit structures, and SLAs.
Proactively identify and address backlogs, errors, and operational risks.
Coordinate dependencies across upstream and downstream workflows.
2. Quality, Accuracy & Compliance
Ensure high accuracy in member eligibility, group setup, and benefit configuration to prevent claim errors and rework.
Monitor claims and adjustments for correct application of advantages, pricing, and policy rules.
Conduct regular quality checks, audits, and case reviews.
Identify error trends, perform root‑cause analysis, and drive corrective actions.
Ensure compliance with healthcare regulations, audit requirements

📌 Claims Supervisor (India)
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