State Manager|Health Claims|Madhya Pradesh

2 weeks ago

Remote, India Optimus Medical Services Full time ₹ 4,20,000 - ₹ 6,00,000 per year

Key Responsibilities:

  • Oversee and manage health claim operations (cashless, reimbursement, and PA claims) across the assigned state.
  • Ensure adherence to TATs, quality standards, and claim handling guidelines.
  • Supervise, train, and support a team of field investigators, medical reviewers, and coordinators.
  • Monitor daily case allocation, field visit performance, and reporting accuracy.
  • Ensure timely submission of investigation reports and communication with insurance company representatives.
  • Liaise with hospital authorities, TPAs, and clients to resolve claim-related issues.
  • Track performance metrics and prepare weekly/monthly MIS reports.
  • Identify process gaps and implement corrective actions to improve operational efficiency.
  • Ensure compliance with company policies, data security norms, and regulatory guidelines.
  • Support business expansion initiatives and coordinate with the Business Development and Quality teams.

Required Qualifications & Skills:

  • Education: Graduate / Postgraduate , Healthcare, Insurance, or related field.
  • Experience: Minimum 5–8 years of experience in health insurance claims / investigation / hospital operations, with at least 2–3 years in a supervisory or managerial role.
  • Skills:
  • Strong understanding of health insurance claim processes and documentation.
  • Excellent leadership, communication, and stakeholder management skills.
  • Proficiency in MS Office and data reporting tools.
  • Problem-solving ability and decision-making skills under tight deadlines

Job Types: Full-time, Permanent

Pay: ₹420, ₹600,000.00 per year

Work Location: Remote

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