Head of Claims Management

17 hours ago

Delhi Mumbai NCR, India Skillventory Full time ₹ 20,00,000 - ₹ 25,00,000 per year

  • Strategic Leadership

  • Develop and execute the overall claims management strategy aligned with the organizations business objectives.

  • Drive transformation of claims processes with a focus on efficiency, transparency, and superior customer experience.

  • Establish and enforce governance frameworks, policies, and compliance standards.

  • Operations & Process Excellence

  • Lead end-to-end claims operations, ensuring timely, accurate, and fair settlement.

  • Apply modern operational methodologies such as Lean, Theory of Constraints, and Six Sigma to improve throughput, reduce costs, and eliminate inefficiencies.

  • Implement robust controls to minimize fraud and leakages.

  • Clinical & Medical Oversight

  • Provide clinical insights into claims assessment, policy interpretation, and adjudication.

  • Ensure medical appropriateness of claims decisions while balancing cost management and patient outcomes.

  • Serve as the company's medical authority in disputes and complex claim cases.

  • Technology, Data & Analytics

  • Leverage advanced analytics, AI, and machine learning to automate claims adjudication, identify anomalies, and detect fraud patterns.

  • Drive digital transformation of claims processes, including seamless integration with provider networks and customer platforms.

  • Use data-driven insights to inform decision-making and improve operational KPIs.

  • Stakeholder Management & Communication

  • Collaborate with internal teams (underwriting, provider relations, product development, IT, and customer service) to align claims management with business goals.

  • Represent the company in external forums, regulator interactions, and industry associations.
  • Deliver high-impact presentations to the Board, investors, and senior leadership.Role & responsibilities

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