Claims Supervisor

About Us

At CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities and shareholders every day.

One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We’re devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being.

CIGNA Healthcare believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization.

Working at CIGNA Healthcare will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us!

Process Overview*

• Global insurance claims processing for individual, employer and group.

Job Description*

• The Claims Supervisor will lead a team responsible for accurate and timely processing of healthcare claims (professional/institutional) while ensuring adherence to client policies, regulatory requirements, and internal quality standards. This role focuses on daily operations management, team performance, quality/compliance, production attainment, people leadership, and continuous improvement across claims processing workflows.

Responsibilities: -

1) Team Leadership & Daily Operations

• Supervise day-to-day claims processing operations to meet SLA/TAT, productivity, and quality targets.
• Allocate work, manage volumes, and ensure queue hygiene, balanced distribution, and timely completion of deliverables.
• Provide floor support and real-time resolution for processing queries and escalations.

2) Claims Processing Oversight (Technical & Functional)

• Guide the team on claims handling across key areas such as:
  • Claims intake, validation, adjudication support and pends
  • Error identification and correction, resubmissions, and recoupment workflows (as applicable)
  • Coordination of Benefits (COB)
• Ensure correct application of standard claims concepts (as applicable to process):
  • Eligibility, benefits, pre-auth/referrals, medical necessity indicators
  • Code familiarity: CPT/HCPCS/ICD-10 (conceptual), modifiers, NCCI awareness (nice-to-have)

3) Quality, Compliance & Audit Readiness

• Drive adherence to SOPs, WIs, and control checks; ensure zero tolerance compliance items are met.
• Conduct regular audits/quality calibrations, coach for error reduction, and maintain documentation for governance.
• Ensure process alignment with HIPAA/privacy norms and internal data handling guidelines.

4) Performance Management & Coaching

• Set clear expectations, conduct huddles/1:1s, and provide ongoing coaching on quality, productivity, and behaviors.
• Create development plans for team members; identify training needs and coordinate refreshers.
• Manage attendance, schedule adherence, and engagement levers; address performance gaps through structured action plans.

5) Stakeholder & Client Communication

• Provide daily/weekly operational updates to managers and cross-functional teams (Quality, Training, WFM, Tech).
• Participate in client calls as needed, share performance narratives, and support action plan tracking.
• Drive effective escalation management with clear RCA and preventive actions.

6) Continuous Improvement (CI) / Automation Mindset

• Identify defect trends, run basic analysis, and implement corrective/preventive actions.
• Lead mini-projects to improve First Pass Yield (FPY), reduce rework, and improve throughput.
• Support digitization/automation initiatives (macros, workflow improvements, knowledge articles) in partnership with OE/Tech.

KPIs: -

• SLA / TAT adherence (queue-based and end-to-end as applicable)
• Productivity / throughput per FTE
• Quality score / audit compliance / error rate
• Rework reduction, FPY improvement
• Shrinkage/attendance, schedule adherence
• Team attrition, engagement, coaching effectiveness
• Client/Stakeholder satisfaction and escalation closure timeliness

Required Qualifications:

• 5-6 years of experience in International Healthcare Claims Operations (payer/TPA/provider revenue cycle claims teams supporting payer processes).
• Minimum 3-4 years in a lead/team supervisor/team lead.
• Strong understanding of claims concepts: adjudication flow, denials, adjustments, benefits/eligibility basics.
• Ability to interpret SOPs, apply judgement, and drive operational discipline.
• Excellent communication (verbal/written), stakeholder management, and people leadership skills.
• Strong working knowledge of MS Office (Excel, PowerPoint); comfort with dashboards and trackers.

Preferred Experience:

• Experience with claims platforms/workflows (payer tools), OCR/intake tools, or BPM/queue management systems.
• Exposure to Lean/Six Sigma, Kaizen, or structured CI methods.
• Prior experience working in regulated environments with audit rigor (internal/external).
• Familiarity with provider contracting concepts and network/COB scenarios.

Competencies and Behaviours:

• Customer-first mindset with strong attention to detail
• Bias for action and outcome orientation
• Strong analytical and problem-solving capability
• Ability to lead through change; coach and motivate teams
• High integrity, compliance orientation, and confidentiality handling

Education*: Graduate (Any) - medical, Paramedical, Commerce, Statistics, Mathematics, Economics or Science.

Experience Range*: Minimum 5 years in EU/US/Global health insurance claims industry, includes hands-on experience on claims processing of at least 4 years and 3-4 years in managing team of 12-15 members/associates.

Work Timings*: 1:00-10:00 PM IST

Job Location*: Bangalore

About The Cigna Group