Job Description

Job Summary & Responsibilities:

Perform adjudication of complex US insurance claims by reviewing policy coverage, claim documentation, and supporting evidence to determine claim eligibility and settlement.

Ensure claims processing complies with US insurance regulations, carrier guidelines, and state DOI requirements .

Supervise and guide claims adjudication analysts , including workload management, quality monitoring, and escalation handling.

Review high-value or escalated claims cases requiring advanced coverage interpretation and settlement decisions.

Ensure compliance with prompt claim settlement timelines and regulatory mandates across applicable states.

Maintain active or required adjuster licensing/certification , particularly for Texas and Florida claims handling where mandated.

Conduct quality checks and audits to ensure accuracy, compliance, and adherence to SLAs.





Collaborate with carriers, TPAs, and internal stakeholders for claim resolution and operational governance.

Support process improvements, compliance readiness, and audit requirements

Skills
US claims adjudication and settlement analysis
Adjuster licensing requirements (Texas / Florida / DHS)
Escalation management
Quality assurance and operational oversight

Note : (Senior pro with Adjudication license is mandatory.

Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Adjudication Specialist Lead Us Insurance Claims Pune
🏢 HNM Sourcing
📍 Pune