Senior Manager

2 weeks ago

Hyderabad Indore, India ICICI Lombard Full time ₹ 4,00,000 - ₹ 12,00,000 per year

Department: Health Claims (Cashless)

Location: Hyderabad 1, Indore 1

Reporting To: Chief Manager Health Management Team

Key Responsibilities:

  • Claims Assessment: Evaluate and process health insurance claims in accordance with policy terms and conditions.
  • Medical Review: Identify and flag potential cases of medical abuse or discrepancies in treatment protocols.
  • Admissibility Decision: Determine claim eligibility based on thorough review of medical documentation and policy guidelines.
  • Tariff Adjudication: Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates.
  • Stakeholder Coordination: Liaise effectively with internal teams, network hospitals, and other external stakeholders to ensure smooth claim processing and resolution.

Qualifications & Skills:

  • MBBS/BAMS/BHMS/BDS or equivalent medical qualification (preferred).
  • Strong understanding of health insurance policies and medical terminology.
  • Analytical mind-set with attention to detail.
  • Excellent communication and decision-making skills.
  • Ability to work collaboratively in a fast-paced environment.
  • Flexible to work in rotational shifts

Experience Required: 4-5 years in Health Insurance Claims/Underwriting/Investigation etc.Role & responsibilities

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