Job Description

Looking for experienced folks from Member or group enrollment process . Job Title: Team Leader Enrollment & Claims Adjudication (US Healthcare) Experience: 5-6 years Qualification: Bachelors degree Shift: Night shift Transportation: Pick up and drop would be provided Job Summary: The Team Leader - Enrollment and Claims Adjudication will oversee a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, client-specific guidelines, and quality standards. The role ensures efficient workflow, team performance, process improvement, and client satisfaction. Key Responsibilities: Team Management & Leadership: Lead, mentor, and manage a team handling enrollment and claims adjudication processes. Monitor team productivity, quality, and adherence to service level agreements (SLAs). Provide training, coaching, and development opportunities to team members. Conduct regular team meetings, performance reviews, and provide constructive feedback. Resolve escalations and complex issues promptly and professionally. Enrollment Management: Oversee new member enrollment, renewals, terminations, and updates in healthcare plans. Ensure data accuracy for member eligibility, coverage, and benefits. Collaborate with clients and internal teams to resolve enrollment discrepancies or queries. Claims Adjudication Oversight: Supervise the processing of healthcare claims ensuring accuracy and compliance with policies, provider contracts, and regulatory guidelines (HIPAA, CMS, etc.). Ensure proper review of claims for eligibility, benefits coverage, coding, and payments. Monitor claim denials and implement corrective action plans to reduce errors and rework. Process & Compliance: Ensure compliance with US healthcare regulations, privacy laws (HIPAA), and client-specific guidelines. Identify process improvement opportunities and work with quality teams to implement best practices. Prepare and analyze reports related to team performance, quality audits, and operational metrics. Liaise with clients and stakeholders for updates, process changes, or reporting needs. Required Skills and Qualifications: Bachelors degree or equivalent work experience in healthcare operations. Minimum 5-6 years of experience in US healthcare processes, with 1-2 years in a team leadership role. SME’S and Quality analysts are eligible to apply Strong knowledge of US healthcare insurance, including enrollment, eligibility, claims processing, and adjudication rules. Familiarity with CMS, Medicaid, Medicare, ACA, and HIPAA regulations. Proficient in claims platforms Excellent analytical, problem-solving, and decision-making skills. Strong communication and interpersonal skills. Ability to multitask and work under pressure. Interested folks can share your updated cv to : sunkari.srikanth@sagilityhealth.com or Whats app your cv to : 9949217482