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
About Accenture
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world's largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
What would you do The Team Lead – Appeals & Grievance (A&G) is responsible for overseeing the daily operations of the A&G 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 A&G processors/analysts Assign workloads and monitor daily productivity and turnaround times (TAT) Conduct regular team huddles, feedback sessions, and performance reviews Provide coaching and training to improve team skills and knowledge Operations & Case Oversight: Oversee the end-to-end appeals and grievance process Review complex or escalated cases and provide resolution guidance Ensure accurate documentation and proper case handling Monitor case queues and ensure adherence to SLAs Compliance & Quality Assurance: Ensure all cases meet regulatory requirements (CMS, HIPAA, and internal policies) Conduct quality audits and provide actionable feedback Identify risks, gaps, and compliance issues, and implement corrective actions Stakeholder 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 management Identify process improvement opportunities and drive efficiency initiatives Support implementation of new policies, systems, and workflows Core Competencies: Strong leadership and team management skills Excellent analytical and problem-solving abilities In-depth knowledge of appeals and grievance processes Understanding of healthcare regulations (CMS, HIPAA) Effective communication and stakeholder management Ability to handle escalations and make decisions under pressure Strong 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 relationship Knowledge of Medicare/Medicaid guidelines Familiarity with medical terminology and claims processing Experience 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, BBA,BCom,BMS
