Head - Accident & Health Claims

4 days ago

India Taglynk Full time

TagLynk Careers, hiring partner for a leading insurance organization, is looking for a senior leader to drive Accident & Health Claims Strategy & Operations . This role is ideal for seasoned professionals with deep expertise in health insurance claims, fraud mitigation, provider network management and regulatory compliance. Key Responsibilities Strategic Leadership Build and drive end-to-end Accident & Health Claims strategy , frameworks and processes. Ensure compliance with latest health insurance regulations; implement process refinements. Lead the move towards paperless, automated claims settlement with superior TAT & customer experience. Design and monitor performance metrics for TPAs and internal claims teams. Collaborate with technology teams to build/enhance claims systems & automation . Build strong partnerships with external stakeholders: TPAs, investigators, hospitals, OSPs, providers . Drive continuous improvement, best practices, and customer-first delivery. Financial & Risk Management Partner with audit & fraud teams to implement fraud prevention and loss-mitigation frameworks . Manage claims budgets, average claims cost and cost-containment initiatives. Analyze ICR , medical data and portfolio trends; drive proactive risk control. Support product, U/W and actuarial teams with insights for guideline finalization. Lead periodic reporting for internal & regulatory stakeholders. Functional & Operational Excellence Lead teams managing claims processing, customer queries, complaints, reserving & registration. Oversee adjudication of complex claims: indemnity, critical illness, accidental death . Manage network providers, evaluate & empanel TPAs/OSPs, drive performance management. Partner closely with product/business teams to strengthen service capability. People Leadership Drive a culture of accountability, high performance and continuous learning. Set goals, mentor teams, review performance, and build future leaders in claims operations. Strengthen collaboration across cross-functional internal teams. Desired Profile MBBS / BAMS / BHMS / B.Pharm preferred; or any graduate with health insurance certifications. 15–20 years of experience in health insurance / TPA / wellness / healthcare domains. Strong exposure to claims operations, adjudication, medical review, fraud control, underwriting basics, hospital administration, and provider network management . Proven leadership in handling large teams and multi-stakeholder environments. Excellent analytical, communication, negotiation and people management skills. Key Stakeholders Internal: Product, U/W, Distribution, Customer Service, Technology, Compliance, Finance External: TPAs, Hospitals, Investigators, Providers, Corporates, Customers

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