Assistant Manager Mass Health Claims

1. Risk Assessment and UW

• Implementation and monitoring of various underwriting guidelines related to Commercial products.
• Main accountability includes Risk analysis, Risk acceptance, Risk selection, Policy coverage (Policy wording, Add-on covers, Exclusions / Inclusions etc.), Renewal business, etc. within the purview of set Underwriting Guideline to achieve the desired business outcomes
• Maintain TAT and compliance as per UW authority matrix.
• Reviewing proposals and providing Inputs in terms of local market dynamics, nature of business, quality of risk and recommendations thereof.
• Strong market intelligence i.e. a broader view of the market we operate in /competitors’ details for formulating internal strategies.
• Work in close coordination with the sales team on the available profitable business opportunities falling with the underwriting guidelines of the company.
• Review the risk based on the market intelligence and based on the third-party risk inspection reports

1. Relationship management

• Interacting with internal stakeholders (Operations, Marketing, Finance, Claims etc.) to meet the smooth proceedings of the business requirements at various stages
• Develop the key relationship with major clients and Intermediaries along with marketing team to develop long term sustainable business growth

1. Analytics & MIS Reporting

• Analyzing the risk and identifying business that can be picked up in declined risk category and seek necessary approvals from seniors/HO for the same

Provider Management: Provider Relationship Management to achieve goal and objective as set including negotiation tariff,

designing packages, customer service, maintaining a good relationship with existing providers  

Identification of Important Providers based on the requirements for Hospital Empanelment and works on strengthening

relationships through value added activities.

Wellness and administrative activities : Coordination for Health camps, business promotion activities through various value

 added services.

 Preparation of Tariff renewal: Preparing and Analysis of claims backed with data pointers for Existing Tariff renewal process

negotiation, support team for audits.

 Skills Required:

 Should be well versed with “health insurance” (In terms of Coverage’s) , Provider Networks & Wellness

 Strong communication skills (Verbal as well as written)

 Should possess excellent soft and negotiation, Marketing skills

 Thorough knowledge of MS-Office especially MS-Excel & MS power point

 Strong in calculations & logical thinking .

Willing to travel is must.

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