Assistant Manager Health Claims Investigation

About Job

• Strong knowledge of health insurance and claims investigation processes
• Excellent communication and interpersonal skills to effectively manage vendors and stakeholders
• Ability to analyze data and identify trends to improve investigation processes
• Strong problem-solving skills to resolve complex claims investigations
• Ability to work efficiently under pressure and meet deadlines
• Proficient in Microsoft Office Suite, particularly Excel, Word, and PowerPoint
• Strong leadership and management skills to effectively manage a team
• Ability to travel to carry out field investigations
  

Responsibilities

• Follow the Standard Operating Procedure (SOP) laid out for Health Claims Investigations
• Takes full responsibility of managing health claims investigations, including allocation of cases to external vendors, follow-up for reports, and quality control of investigation reports
• Will be willing to travel to carry out field investigations
• Ensures to get the investigation reports within the prescribed Turn-Around-Time (TAT)
• Maintains the quality of investigation reports from vendors by conducting regular quality checks
• Provides proactive assistance to the Health Claims team to achieve customer delight and high-level customer satisfaction for the insured and internal stakeholders
• Works efficiently to meet set goals and avoids any escalations to maintain relevance and quality while providing service to stakeholders
• Handles vendor management, including obtaining SLAs and documents for empanelment
• Handles projects and additional tasks assigned