Claims Processing and Adjudication

Tata Consultancy Services · Mumbai, India

Key Responsibilities:

1. Claims Processing & Adjudication:

• Efficiently process and adjudicate India-specific and global benefits claims, ensuring accuracy and compliance with policies.
• Validate claims documentation, including gym reimbursement claims, vaccination claims, wellbeing benefits claims, school reimbursement claims, Salary advance claims etc. for global regions
• Identify discrepancies in claims and ensure timely resolutions in line with company guidelines
• Experience in similar claim processing is a must
• Knowledge and working experience of Darwin and Workday is a plus
• Knowledge of ticket management tools like SNOW is a Plus.

1. Stakeholder Engagement:

• Collaborate with global stakeholders to align claims processing practices with global standards.
• Communicate effectively with internal teams, external vendors, and claimants to ensure smooth claim management.

1. SLA & KPI Management:

• Demonstrate a strong understanding of Service Level Agreements (SLAs) and Key Performance Indicators (KPIs).
• Consistently meet or exceed SLA requirements for claims processing while maintaining high-quality standards.

1. Policy Adherence & Process Improvement:

• Ensure adherence to company policies, local regulations, and international best practices in claims management.
• Proactively identify and recommend process improvements to enhance efficiency and accuracy.

Qualification & Skillset:

• Graduate and specialization in Human resources
• 5–6 years of experience in India / Global claims processing and adjudication.
• Strong understanding of various types of claims, advances , reimbursements and benefits eligible for claims
• Expertise in verifying and validating claim-related documents.
• Exceptional command of English , with the ability to communicate fluently and professionally.
• Attention to detail
• Proven experience collaborating with global stakeholders across regions.
• Deep understanding of SLAs and KPIs and a track record of achieving or exceeding them.

Key Skills:

• Proficiency in Italian Language (written and verbal)
• Claims Processing experience including gym reimbursement claims, vaccination claims, wellbeing benefits claims, school reimbursement claims, Salary advance claims etc. for global regions
• Knowledge of Darwin and Workday tool – is an advantage
• Documentation Validation
• Global Stakeholder Management
• Process Improvement and Compliance
• SLA & KPI Adherence
• Excellent Communication and Analytical Skills

Working Conditions:

• Work Shift will be dependent on geography/region coverage requirements across a 24-hour * 7 service delivery
• Work from Office (No work from home)
• Agile to extended work hours when needed to meet deadlines without prompting.