Claims Manager-A&H

Role Overview: You will be responsible for conducting closed file review and audits, both for third party administrators and in-house claims processing. Your duties will include identifying areas for improvement, recovering funds from third party administrators for error-prone claims, and generating monthly reports. Key Responsibilities: - Conduct closed and open file reviews for third party administrators and in-house claims - Identify and recover funds from third party administrators for claims processed with errors - Highlight areas for improvement in the claims processing workflow - Publish monthly reports summarizing audit findings Qualification Required: - Degree in medicine (BHMS/BAMS/MBBS) - Minimum 7 years of experience in general insurance Accident & Health claims - In-depth knowledge of medical cases and policy coverages for OPD, hospitalization, personal accident, and travel claims - Previous experience in audit - Good interpersonal skills - Proactive and effective learner - Good analytical, communication, and negotiation skills - Familiarity with Basic Microsoft Excel and regulatory changes,