Job Description

The Manager Claims is responsible for maintaining the establishment of claims philosophy and procedures.

The role is also responsible to ensure that the claims activities are well managed at the branch / hub; training of the vendors to ensure quality output; compliance to regulatory, IFIM & other internal guidelines; prepare periodic metrics on claims; implementation of the claims system; assessment and review of claims on an ongoing basis and team management within the Claims Function.

Key Result Areas

Assessment of claims

Assist in establishing claims philosophy for all channels of business and preparation of plan to achieve targets with adherence to the philosophy.

Prepare feedback & input for various departments like New Business, Actuary, Underwriting and Policy servicing through the Claims Committee.

Prepare the various dashboards for management reporting

Claims Process and Procedure

Assist in preparing and updating the standard processes & procedures, formats and documentation.

Conduct training sessions as and when required.

Monitor the SLA's with various departments to ensure adherence.

Resolve escalated inquiries & complaints by liaising with resolution centre.

Update and implement appropriate claims administration & reporting system.

Develop MIS and dashboards on various parameters for an effective analysis and insight to the performance of the unit.

Assist in Reinsurance Management

Drafting Query to Doctors pertaining to specific illness under Critical Illness.

Development and Implementation of Fraud management plan for the organization.

Developing tools and techniques for detection and deterrence of fraud

Compliance Management

Understand and adhere to the regulations relating to the functioning of the Claims unit.

Achieve satisfactory rating in all compliance & audit reviews

Claims System Management

Preparation of meticulous BRs

Preparation of Health claims scenario and UAT

Delivering the functionalities within time

Team Management

Hiring quality people and mentor them

Performance feedback

Develop suitable reward and recognition programs.

Retention of Key performers

Job Type: Permanent

Pay: ₹1,200,000.00 - ₹1,600,000.00 per year

Benefits:

Health insurance Provident Fund
Work Location: In person