Key Roles & Responsibilities  Primary Role Description  - This role is responsible for the smooth operational functioning of the Claims function   - The role will also be responsible for managing the claims ratio for the organisation  Key Roles & Responsibilities  - Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.  - Resolve complex, severe exposure claims, using high service oriented file handling.  - Pay and process claims within designated authority level.  - Examine claims investigated by claims Hubs, further investigating questionable claims to determine whether to authorize payments.  - Recruit, empower, plan and lead the claims operations team of the hubs  - Development and publication of adjudication guidelines to the processors for standardization  - Monitoring team's performance against the agreed organizational objectives  - Innovate and drive improvement initiatives in the process  - Deliver exceptional customer experience by timely and error free processing of claims  - Scrutiny of claim files and cashless request  - To ensure adherence to TAT in various sub processes in claims function.  - To monitor and control error rates and consistency in processing.  - To review SOP for claims processing and to develop & execute better processes.  - To monitor and appraise performance of doctors working under vertical.  - To monitor customer complaints, trend and timely resolution.  Key Requirements - Education & Certificates  - Medical graduate or postgraduate (in any line of allopathy)  - PG qualification in Management will be a distinct advantage   - Proficient user of Microsoft Office packages (Excel, Word, PowerPoint, Outlook)  Key Requirements - Experience & Skills  - Should have around 12 to 15 years of experience in Claims/ Risk management   - Strong hand on clinical knowledge and its practical application mandatory  - Experience in partner relationship management, provider network and legal representation is desired  - Strong communication and negotiation skills   - Sound insurance industry knowledge  - Best practices knowledge  - Experience of handling a large team of people with diverse experience and exposure

Delhi NCR

Vice President - Claims/Risk Management - Insurance 

Vice President - Claims/Risk Management - Insurance  ,Job Description for Vice President - Claims/Risk Management - Insurance  in Winning Edge India in  Delhi NCR for (12-15) years of experience. Apply Now!

Job Description for Vice President - Claims/Risk Management - Insurance  in Winning Edge India in  Delhi NCR for (12-15) years of experience. Apply Now!