
Senior Claims Manager Position
6 days ago
Claims Management Leader
\This is an exciting opportunity to lead and oversee a team of claims professionals in a fast-paced insurance environment. As Claims Management Leader, you will be responsible for ensuring smooth and efficient claims processing across cashless and reimbursement cases.
\You will have strong expertise in handling Employee Benefits (EB) claims processes, including cashless and reimbursement claims. Proven experience in managing teams and stakeholder relationships in the TPA/insurance domain is also essential.
\Your role will involve both strategic leadership and hands-on operational management to ensure SLA adherence, client satisfaction, and accurate claims resolution. You will work closely with TPAs, insurers, and client HR teams to resolve claims-related escalations and queries.
\Key responsibilities include:
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- Team Leadership & Operations:\
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- Lead, mentor, and manage a team of claims professionals to achieve performance benchmarks and minimize escalations.\
- Allocate workload effectively, monitor productivity, and ensure adherence to quality standards.\
- Conduct regular training sessions to enhance team knowledge on policy terms, insurance guidelines, and process updates.\
- Drive process improvements and automation initiatives to enhance efficiency.\
- Claims Management:\
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- Oversee end-to-end processing of EB claims (cashless & reimbursement) while ensuring compliance with policy terms and regulatory guidelines.\
- Review denial claims shared by TPAs and validate them against policy conditions.\
- Represent client claims to insurers/TPAs in case of settlement or denial ambiguities.\
- Provide subject matter expertise on medical practices and insurance policies during claim reviews.\
- Stakeholder Management:\
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- Build and maintain strong relationships with TPAs and insurers to ensure SLA adherence and timely claims settlement.\
- Collaborate with client HR teams to resolve claims-related escalations and queries.\
- Communicate policy terms, claims procedures, and resolutions effectively to clients via calls, emails, or meetings.\
- Visit insurer offices when required to expedite approvals and resolve complex claims.\
- Compliance & Reporting:\
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- Ensure compliance with IRDAI health insurance regulations and company policies.\
- Monitor and track payment cycles, denial trends, and settlement turnaround times.\
- Support the Analytics team with data insights and claims trend analysis.\
- Prepare periodic MIS/reports for management on claims performance, outstanding amounts, and process efficiency.\
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