Job Description

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 Health Insurance, TPA 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: ₹35,000.00 - ₹60,000.00 per month

Work Location: In person