Senior Manager

2 weeks ago

Bengaluru, Karnataka, India Prudent Insurance Brokers Pvt Ltd. Full time

Job Summary:

The position will involve claims analysis and processing facilitation in coordination with different TPA's and Insurance companies.

Responsibilities:

  • Leading team and reduce escalations to the maximum extent possible.
  • Managing relations with TPAs/Insurers to ensure claims SLA is maintained.
  • Interacting with client HRs to resolve their claims related queries, if required.
  • Explaining clients on the policy terms related queries over the call or mail.
  • Reviewing denial claims sent by TPAs & ensuring that denial is done as per policy terms.
  • Representing client claims to insurer/TPA in case of ambiguity in settlement/denial
  • Supporting Analytics team in data analytics.
  • Managing the assigned team members day to day activity & their productivity to ensure excellent client experience.
  • Visiting insurer office whenever required to get the necessary approvals on claims.
  • Supporting client servicing teams in claims related issues whenever required.

Desired profile/who should join:

  • Should be a graduate with any specialization.
  • Should have 10-15 years of experience in Managing EB Claims teams processing (Cashless/Reimbursements)
  • Good knowledge about the TPA/Insurance processes
  • Well verse with health insurance policy conditions
  • Well verse with current medical practices & advancements
  • Should have knowledge about IRDA health regulations
  • Good communication skills
  • Problem solving attitude
  • Team leading
  • Mentoring Skills
  • Decision making
  • Good team manager

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