Head - Accident & Health Claims

4 days ago


Bengaluru, Karnataka, India Taglynk Full time ₹ 12,00,000 - ₹ 36,00,000 per year

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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