Role Overview
The Claims Supervisor is accountable for the accurate, timely, and compliant adjudication of health and benefits claims in line with contractual benefits, regulatory requirements, and company policies.
The role provides daytoday people leadership, technical oversight, and quality governance to ensure consistent delivery against key performance indicators (KPIs), including turnaround time (TAT), accuracy, service level agreements (SLAs), and performance guarantees. The Supervisor plays a critical role in strengthening service quality, mitigating operational and financial risk, and driving continuous improvement.
Key Responsibilities
Claims Delivery & Governance
- Oversee endtoend claims adjudication to ensure accuracy, consistency, and compliance with policies, procedures, and benefit rules.
- Ensure claims are processed within agreed SLAs by monitoring daily workloads, redistributing work as required, and proactively addressing delivery risks.
- Act as an escalation point for complex, highvalue, sensitive, or disputed claims, providing technical review and decision support.
- Ensure compliance with audit standards, regulatory requirements, and data privacy obligations.
- Identify, manage, and escalate operational and financial risks appropriately.
Performance Management & Insights
- Monitor individual and team KPIs, including productivity, accuracy, TAT, quality scores, and adherence.
- Analyze claims trends, error drivers, and root causes, translating insights into corrective and preventive actions.
- Use data and reporting to support evidencebased decisionmaking and continuous performance improvement.
- Participate in audits, root cause analysis, and remediation activities, ensuring timely followup on action items.
People Leadership & Capability
- Provide daytoday leadership, coaching, and guidance to drive accountability and high performance.
- Conduct regular team meetings and onetoone sessions to review results, address issues, and communicate priorities or changes.
- Support onboarding, training, and ongoing upskilling of team members.
- Identify training gaps and recurring errors, partnering with training and quality teams to implement targeted interventions.
- Foster a positive, engaged, and accountable team culture aligned with company values.
Continuous Improvement & Change
- Support and/or lead process improvement initiatives, including workflow optimization, standardization, and automation opportunities.
- Ensure consistent understanding and application of benefit interpretations, medical terminology, and adjudication rules.
- Lead and implement leadershipassigned actions and initiatives, tracking progress, managing risks, and ensuring timely execution.
- Take ownership of team outcomes and demonstrate professionalism and sound judgment in all interactions.
Requirements
- 57 years experience in medical claims processing or insurance operations.
- Minimum 3 years experience in a supervisory or team leadership role.
- Strong knowledge of health insurance products, benefit structures, claims adjudication, and medical terminology.
- Proven people management and coaching capability.
- Datadriven mindset with strong problemsolving and decisionmaking skills.
- Excellent organizational and prioritization skills in a fastpaced environment.
- High level of integrity and discretion in handling confidential information.
- Strong proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and reporting tools.
Leadership Competencies
- Strategic Thinking
- Operational Excellence
- Change Management
- Collaboration & Influence
- Decision Making & Problem Solving
- Emotional Intelligence
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.
