Delivery Operations Senior Analyst
Accenture · Mumbai · onsite · Posted 29d ago
Undisclosed5–8 yrsfulltimeSourced from
About a minute. You'll make an account on the way through.
About this role
About The Role
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
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What would you do
The Team Lead – Appeals Grievance (AG) is responsible for overseeing the daily operations of the AG 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 AG processors/analystsAssign workloads and monitor daily productivity and turnaround times (TAT)Conduct regular team huddles, feedback sessions, and performance reviewsProvide coaching and training to improve team skills and knowledgeOperations Case Oversight:Oversee the end-to-end appeals and grievance processReview complex or escalated cases and provide resolution guidanceEnsure accurate documentation and proper case handlingMonitor case queues and ensure adherence to SLAsCompliance Quality Assurance:Ensure all cases meet regulatory requirements (CMS, HIPAA, and internal policies)Conduct quality audits and provide actionable feedbackIdentify risks, gaps, and compliance issues, and implement corrective actionsStakeholder 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 managementIdentify process improvement opportunities and drive efficiency initiativesSupport implementation of new policies, systems, and workflowsCore Competencies:Strong leadership and team management skillsExcellent analytical and problem-solving abilitiesIn-depth knowledge of appeals and grievance processesUnderstanding of healthcare regulations (CMS, HIPAA)Effective communication and stakeholder managementAbility to handle escalations and make decisions under pressureStrong 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 relationshipKnowledge of Medicare/Medicaid guidelinesFamiliarity with medical terminology and claims processingExperience 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
QualificationBBA,BCom,BMS
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
What would you do
The Team Lead – Appeals Grievance (AG) is responsible for overseeing the daily operations of the AG 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 AG processors/analystsAssign workloads and monitor daily productivity and turnaround times (TAT)Conduct regular team huddles, feedback sessions, and performance reviewsProvide coaching and training to improve team skills and knowledgeOperations Case Oversight:Oversee the end-to-end appeals and grievance processReview complex or escalated cases and provide resolution guidanceEnsure accurate documentation and proper case handlingMonitor case queues and ensure adherence to SLAsCompliance Quality Assurance:Ensure all cases meet regulatory requirements (CMS, HIPAA, and internal policies)Conduct quality audits and provide actionable feedbackIdentify risks, gaps, and compliance issues, and implement corrective actionsStakeholder 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 managementIdentify process improvement opportunities and drive efficiency initiativesSupport implementation of new policies, systems, and workflowsCore Competencies:Strong leadership and team management skillsExcellent analytical and problem-solving abilitiesIn-depth knowledge of appeals and grievance processesUnderstanding of healthcare regulations (CMS, HIPAA)Effective communication and stakeholder managementAbility to handle escalations and make decisions under pressureStrong organizational and time management skills
What are we looking for
Roles and Responsibilities:
QualificationBBA,BCom,BMS
Sourced from naukri
Skills
customer satisfactionCMSReporting toolsProcess ImprovementHealthcarecloudQuality AssuranceRegulatory ComplianceMedicalStakeholder ManagementoperationsAdministrationclient relationshipcomplianceClaims ProcessingCoaching
About Accenture
Accenture
IT Services & Consulting
350k+
employees
1989
37 years old
Dublin
Ireland
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Accenture plc is an Irish-American, professional services company based in Dublin, specializing in information technology services and consulting.
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