Lead-Claims Adjudication-Thryve Digital Health LLP

Role: Team Lead - Claims Adjudication

Position: Non-Technical

Skill: Claims Adjudication (US Healthcare Process)

Shift: 11:00 AM - 8:00 PM IST

Work Location: Chennai

Work Mode: Onsite (all 5 days work from office)

Venue: SEZ, Ramanujan IT City, 6th Floor Cambridge Tower, SH 49A, Tharamani, Chennai, Tamil Nadu 600113, India

Role Summary:

This job takes the lead in handling a team of 25-30 team members providing complex claims adjudication services typically as part of the Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies. Claims Adjudicators provide general support to maintain TAT, meet SLAs, performance and quality levels required by their customers. Mentor and motivate team members.

Essential Responsibilities:

• Adhere to organizational policies
• Handle a team of 20-25 associates
• Deliver SLAs and closely monitor team performance and risks
• Drive innovation within the team
• Process claims alongside the team to stay updated on business protocols
• Manage attrition and retention; talent retention focus
• Perform succession planning and early warning signal forecasting
• Oversee learning compliance (self and team)
• Create, maintain, and share dashboards with leadership
• Drive employee engagement and team-building activities

The experience we are looking to add to our team require:

• More than 8 years of experience in US Healthcare
• Bachelor's or Master's degree in any discipline
• Strong verbal and written communication skills
• Excellent analytical and interpersonal skills
• Exceptional people management skills

Good to Have:

• AHM or any equivalent certification
• Acquaintance with Six Sigma methodology and tools
• Business knowledge in Adjustments and Offset/Recovery