Job Description

Role & responsibilities Driving health claims strategy formulation and setting up processes for the function. Leading a team handling claims, customer queries & complaints, claim adjudication & registration, quality management, analytics etc.. Formulating & ensuring claims/reimbursements settlements with superior TAT & customer experience. Analyzing incurred claim ratio, review of the portfolio & taking proactive action for loss control measures. Developing & implementing health claims fraud prevention & loss mitigation framework. Training & development of medical processors. Identifying key learning, gaps and opportunities for individuals to develop the team. Drive continuous improvement and assist team as and when vital to make the business run effectively and efficiently. Ensure that the highest possible levels of customer service are delivered at all the times Preferred candidate profile Knowledge of healthcare / clinical domain Minimum 10 yrs or 7 yrs of TPA experience Knowledge of Indian health insurance systems and processes. Claims knowledge for health insurance of PSUs Health Insurance/TPA/ Hospital / Clinical Practice Perks and benefits