
Leadership Role: Claims Management
5 hours ago
The position involves claims analysis and processing facilitation in coordination with different third-party administrators (TPAs) and insurance companies. This role requires strong leadership skills to lead a team and reduce escalations.
Responsibilities include:
- Leading a team and minimizing escalations
- Managing relations with TPAs/insurers to maintain claims service level agreements (SLAs)
- Interacting with client human resources (HRs) to resolve claims-related queries, if required
- Explaining clients about policy terms and conditions related queries over calls or emails
- Reviewing denial claims sent by TPAs and ensuring that denials are made as per policy terms
- Representing client claims to insurer/TPA in case of ambiguity in settlement/denial
- Supporting analytics teams in data analytics
- Managing assigned team members' day-to-day activities and productivity to ensure excellent client experience
- Visiting insurer offices when necessary for approvals on claims
- Supporting client servicing teams in claims-related issues, if needed
Desired profile:
- Graduate with any specialization
- 10-15 years of experience in managing enterprise business (EB) claims teams processing (cashless/reimbursements)
- Familiarity with health insurance policy conditions
- Familiarity with IRDA health regulations
- Good communication skills
- Problem-solving attitude
- Team leadership
- Mentoring skills
- Decision-making abilities
- Effective team management
We offer a dynamic work environment where you can utilize your skills and knowledge to drive results. If you have a passion for leading teams and resolving complex claims-related issues, this could be the perfect opportunity for you.
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