Magma HDI General Insurance - Senior Manager - Health Claims Management

Position Title: SM Health Claims Management

Level/Grade/Designation: Senior Manager

Locations: Mumbai - Vidyavihar

Department: Underwriting

Total Work Experience: 6 to 12 years

Education: Doctor (MBBS / Non MBBS) and / or MBA, with Minimum experience of 5 to 8 years of relevant experience in Health insurance claims management.

MBA candidate would be given preference

Purpose :

- Will be directly responsible to for managing health and accident claims

- Responsible for handling a team size of 2 to 4 members.

Duties And Responsibilities :

- Manage a team of Doctors and executives to manage group health, personal accident, Travel and workmens compensation claims

- Manage multiple service partners like TPAs to ensure seamless claims operations across health claims.

- Monitor all aspects of the service delivery in accordance with the contractual commitments and SLA commitments to different stakeholders. Needs to ensure that the delivery is done in accordance with the same.

- To undertake regular TPA audits to identify inefficiencies and to achieve savings through such audits.

- Guide claims IT systems designing and ensuring delivery of the same.

- This role will review service partners and define SLAs for their functions which will impact claims processing and ensure there is collaboration with the respective function heads.

Reporting relationship : Whom the Job Reports to Lead health claims management

Who Reports to the Job Assistant / Deputy Manager / Manager Health claims management

Relationships :

Internally [Within Magma)

Who ? - Purpose of Interaction

- Health Claims - Claims

- Group Health UW - Claims MIS

- Corp Sales and Broking - Claims Services

Who ? Purpose of Interaction

Externally [Outside Magma]

- TPAs - Audit and review

- Other service partners - Claims Services

- Clients - Claims Service review

Job, roles & responsibilities, specialized skills, competencies, qualifications and experience

- Post graduate with relevant experience in Health Claims management

- Strong proficiency in all areas of Health insurance claims

- High level of accuracy with claim financials:

- Advanced understanding of Claim Best Practices and Business Analytics

- Exceptional negotiation skills and resources that will influence team results

- Strong business acumen and understanding of the fundamental components of Claims, Underwriting, agency relationships, industry strategies and trends

- Extensive knowledge of insurance contracts, investigation techniques, legal requirements and insurance regulation

- Exceptional oral, written, and presentation skills that positively influence a wide audience within and outside the Claim department