Opening is with one of the US based Health insurance company. Position: SM - Health Claims Location - Goregaon (E) 5 Days Working CANDIDATES MUST BE DOCTOR OR B. PHARMA AND FROM INSURANCE BACKGROUND Job Description Job Purpose&nbsp; - Evaluate claims within established legal and management guidelines - Implementation of claims guidelines in a manner that is fair and equitable for both the customer and the Company. - Assessment of claims up to a specified approval limit. Key Responsibilities &amp; Accountabilities&nbsp; - Prompt, efficient and reasonable settlement of claims - Decision support for Indemnity, Critical Illness and Personal accident product. - Preparing Investigation Brief, Settlement sheet, Customer Correspondence, complaint resolution - Coordination with TPA for claims processing - Liaises with the TPA to ensure timely and effective claims processing - Coordinates with TPA for claim communications as defined in follow up matrix of SOP - Compliance of SOP and claims guidelines - Compliance of claims guidelines as outlined in SOP - Coordinates with Finance for payment of claims within specified time as outlined in SOP - Timely escalates key issues - Coordination with Customer service team for claims assistance services - Coordinates with call centre/customer service team for claims assistance services and outbound calling related to claims - Ensure timely MIS communication - Maintain MIS of claims operations in timely and effective manner to facilitate decision making by the Claims Committee/ Senior Management - Closely monitors outstanding claims MIS to ensure Turnaround time of claims settlement - Compliance with reporting requirements- IRDA and Internal in timely manner - Co-ordinates with Compliance and legal department and requirements - Coordinates with legal department on Ombudsman and legal cases pertaining to claims - Resolves claims related complaints efficiently &amp; effectively - Comply with all legal and regulatory guidelines Knowledge / Experience / Skills Minimum Educational qualifications - Medical Graduate preferably M.B.B.S. - Legal/insurance qualification is desirable. No. of yrs of total experience - 7-8 years in Insurance / TPA industry with good knowledge of Health claims assessment and customer service Knowledge: - Knowledge of insurance law or medical terminology. - Thorough understanding of Health Insurance products - Understanding of IRDA guidelines and compliance Skills : - Excellent oral and written communication - Strong team player - Customer Services Skills - Negotiation Skills - Insurance operations Behaviours / Competencies Core soft competencies: - Customer service (Orientation) - Eye for detail - Analysis and problem solving - Strong interpersonal skills Neha Gaba

Mumbai

Senior Manager - Health Claims - MBBS - Health Insurance Firm 

Senior Manager - Health Claims - MBBS - Health Insurance Firm  ,Job Description for Senior Manager - Health Claims - MBBS - Health Insurance Firm  in Virtuoso Recruitment Solutions in  Mumbai for (6-14) years of experience. Apply Now!

Job Description for Senior Manager - Health Claims - MBBS - Health Insurance Firm  in Virtuoso Recruitment Solutions in  Mumbai for (6-14) years of experience. Apply Now!