Manager - Underwriting

1 day ago

Thāne, Maharashtra, India Tata AIA Life Insurance Full time
Job Description

A Position Overview

Position Title

- Manager- Underwriting

Department

- Operations Underwriting

Level / Band

- 401

Role Summary

- Responsible for Health claim processing (including End to End processing of claims) & TAT management
- Expertise in reviewing claim documents, medical opinions and understanding policy terms and conditions
- Risk assessment and triggering verification of suspicious claims
- Should be able to coordinate with FIU team, sales team, product team, legal team, complaints team, vendors etc for claims processing, escalations & litigation cases etc.
- Team management

B Organizational Relationships

Reports To

- Senior Manager

Supervises

- AM

C Job Dimensions

Geographic Area Covered

- Pan India

Stakeholders Internal

- FIU team, sales team, product team, legal team, complaints team

External

- Customer/ Policyholder, Vendor- Prorisk/ Medi Assist

D Key Result Areas

Organization Process

- Key Contribution
- To ensure quality & accuracy of Health Claim processes
- Good knowledge on insurance & products & ability to take claim decisions as per policy terms and conditions
- Ensure 100% quality completion of Claim decision
- Ensure all cases are received by the department as per the specified inter & intra department SLAs.
- Presenting case summary and representing to reinsurers, communicating with distribution stakeholders
- Ensure adherence to defined claims TAT & decision accuracy
- Mentor, guide & train new team members
- Ensure quality & accuracy of Claims process
- Sharing feedback and conducting meetings with the relevant stakeholders time to time
- Evaluate emerging trends, competition practices and propose recommendations to senior management
- Should be able to work on weekends and second shift
- Managing the entire team and responsible for End to end TATs of Health claims as per regulatory guidelines

E Skills Required

Technical

- Medical background- Education - minimum BAMS / BHMS / BDS
- Experience - insurance experience, life + Health UW/claims
- Effective presentation and interpersonal skills
- Good system skills in Excel/Word
- Multitasking

Behavioral

- Essential
- Analytical & Excel Skills
- Communication skills
- Supervising/Leadership skills
- Teamwork Skills
- Influencing skills
- Relationship Building skills
- Decision making skills

F Incumbent Characteristics

Essential

- Qualification
- Doctor

Experience

- 8-12 years of experience in Health claim processing

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