Job Title

Job Summary: The position will involve claims analysis and processing facilitation in coordination with different TPA’s and Insurance companies. Responsibilities: Leading team and reduce escalations to the maximum extent possible. Managing relations with TPAs/Insurers to ensure claims SLA is maintained. Interacting with client HRs to resolve their claims related queries, if required. Explaining clients on the policy terms related queries over the call or mail. Reviewing denial claims sent by TPAs & ensuring that denial is done as per policy terms. Representing client claims to insurer/TPA in case of ambiguity in settlement/denial Supporting Analytics team in data analytics. Managing the assigned team members day to day activity & their productivity to ensure excellent client experience. Visiting insurer office whenever required to get the necessary approvals on claims. Supporting client servicing teams in claims related issues whenever required. Desired profile/who should join: Should be a graduate with any specialization. Should have 10-15 years of experience in Managing EB Claims teams processing (Cashless/Reimbursements) Good knowledge about the TPA/Insurance processes Well verse with health insurance policy conditions Well verse with current medical practices & advancements Should have knowledge about IRDA health regulations Good communication skills Problem solving attitude Team leading Mentoring Skills Decision making Good team manager