Head - Accident & Health Claims

2 weeks ago


Delhi, 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 ResponsibilitiesStrategic LeadershipBuild 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 ManagementPartner 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 ExcellenceLead 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 LeadershipDrive 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 ProfileMBBS / 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 StakeholdersInternal: Product, U/W, Distribution, Customer Service, Technology, Compliance, FinanceExternal: TPAs, Hospitals, Investigators, Providers, Corporates, Customers



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