Job Description

Insurance Claims Manager - Health Claims (MP State Operations)

Location:

Madhya Pradesh

Department:

Health Insurance Claims

Reporting To:

State Head / Operations Head

Role Summary

The Insurance Claims Manager - Health Claims will be responsible for managing and overseeing end-to-end health insurance claims operations across Madhya Pradesh. The role involves ensuring timely claim processing, compliance with policy guidelines, coordination with hospitals and field teams, and maintaining high service quality and TAT adherence.

Key Responsibilities

Manage

end-to-end health insurance claims operations

for Madhya Pradesh state. Ensure

timely processing, adjudication, and settlement

of cashless and reimbursement claims. Monitor and improve

Turnaround Time (TAT)

and operational efficiency. Coordinate with

hospitals, TPAs, insurers, and network partners

. Handle

complex, high-value, and escalated claims

. Ensure adherence to

IRDAI regulations, policy terms, and internal SOPs

. Supervise and guide

state-level claims teams and field officers

. Conduct

quality audits

and implement corrective actions. Analyze claims data to identify

fraud, leakage, and trends

. Prepare and present

MIS reports

to management. Support empanelment, renewal, and performance review of network hospitals. Drive

process improvements and cost containment initiatives

.

Eligibility & Qualifications

Bachelor's degree in any discipline (MBA/PG preferred).

6-10 years

of experience in

health insurance claims management

. Prior experience handling

state-level operations

is mandatory. Strong knowledge of

cashless & reimbursement claims

, policy interpretation, and medical terminology. Working knowledge of

IRDAI guidelines

. Experience in managing

field officers / off-roll teams

will be an added advantage.

Skills & Competencies

Strong leadership and people management skills. Excellent communication and negotiation abilities. Analytical mindset with attention to detail. Ability to manage escalations and meet strict deadlines. Proficiency in MS Excel, MIS reporting, and claims systems. Willingness to travel within Madhya Pradesh.
Job Types: Full-time, Permanent

Pay: ?35,000.00 - ?50,000.00 per month

Work Location: In person