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
endtoend 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
- 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.
- 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 benefits, pricing, and policy rules.
- Conduct regular quality checks, audits, and case reviews.
- Identify error trends, perform rootcause analysis, and drive corrective actions.
- Ensure compliance with healthcare regulations, audit requirements, data privacy standards (HIPAA/GDPR as applicable), and internal controls.
- People Leadership
- Lead and support a team of Claims Processors, Eligibility Analysts, and Onboarding Specialists (typically 1020 FTE).
- Set clear performance expectations and provide ongoing coaching and feedback.
- Support new hire onboarding, training, and crossskilling across processes.
- Conduct regular performance discussions and contribute to formal reviews.
- Build a culture of accountability, collaboration, quality, and customer focus.
- Performance Management & Reporting
- Track daily and weekly performance against productivity, SLA, TAT, quality, and adjustment metrics.
- Prepare and share operational dashboards and reports with Senior Supervisors / Managers.
- Monitor rework, adjustment volumes, and upstream error leakage.
- Use data to highlight risks, trends, and improvement opportunities.
- Drive focused action plans to close performance gaps.
- Process Improvement & Change Support
- Identify opportunities to improve process efficiency, firsttimeright outcomes, and member experience.
- Participate in process improvement, standardisation, and automation initiatives.
- Support implementation of new products, benefit changes, group renewals, and system enhancements.
- Act as a change champion, ensuring smooth adoption within the team.
- Stakeholder Collaboration
- Work closely with Quality, Training, Claims, Enrollment, Configuration, Technology, and Onshore Teams.
- Coordinate issue resolution related to eligibility errors, group setup defects, and claim reprocessing.
- Provide timely operational updates, risks, and dependency insights to leadership.
Your Profile
Experience
- 10 years of experience in healthcare operations, with handson exposure to:
- Claims processing and adjustments
- Eligibility and enrollment
- Member onboarding
- Group setup / benefit configuration
- 13 years in a Team Lead or Supervisory role.
- Experience working in highvolume, SLAdriven healthcare environments.
- Strong understanding of endtoend healthcare operations and interdependencies.
Skills & Capabilities
- Solid understanding of claims adjudication, benefit interpretation, eligibility rules, and adjustments.
- Working knowledge of group setup, benefit plans, and configuration accuracy.
- Strong analytical and problemsolving skills.
- Proficiency in Excel and operational reporting tools.
- Ability to manage multiple workflows and competing priorities.
- Clear and effective communication skills.
- Handson experience with healthcare systems and workflow tools.
Behavioural Attributes
- Resultsoriented with strong ownership and attention to detail.
- Qualityfocused with a compliance mindset.
- Calm under pressure and effective in operational issue resolution.
- Collaborative, approachable, and supportive leader.
- Adaptable and open to change with a continuous improvement mindset.
- High integrity and customercentric approach.
Key Competencies
- Frontline people leadership
- Operational execution & discipline
- Quality and compliance focus
- Crossprocess coordination
- Datadriven performance management
- Problem solving & rootcause analysis
- Stakeholder collaboration
- Change adaptability
About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
