Manager - Claims - Insurance

Purpose of role:

- Medical decision on admissibility of claims

- Delivering on Customers commitments, adherence of SLA & Policy T & C

Key responsibilities:

- To do scrutiny of claim files and give opinion on decision.

- To ensure timely processing of claims and accurate payments of claims.

- To ensure adherence to TAT in various sub processes in claims department.

- To review IRs /rejections of claims and implementation of actionable periodically.

- To monitor and control error rates and consistency in processing.

- To Monitor Productivity in Claims processing and Cashless processing.

- To review SOP for claims processing and to develop & execute better processes.

- To manage individual KRAs for achieving organizational goal.

- To monitor and appraise performance of doctors working under vertical.

- Review of Daily MIS to manage inflows and outflows of claims

- To monitor customer complaints, trend and timely resolution.