Corporate Manager - Medical Claims - MBBS

Responsibilities:

• Team Management:

  Lead and manage a team responsible for the processing of medical claims, ensuring high standards of efficiency and accuracy.

• Claim Evaluation & Decision Making:

  Oversee and make critical decisions regarding the genuineness and validity of customer claims. This includes evaluating claims against policy terms and medical documentation to ascertain the appropriateness of the treatment.

• Policy & Medical Compliance:

  Ensure that all claim decisions are strictly in line with established company policy guidelines and align with medical best practices and documentation.

• Quality Assurance:

  Implement and monitor quality control measures for claim processing, identifying areas for improvement and ensuring consistent accuracy.

• Discrepancy Resolution:

  Guide the team in resolving discrepancies in claims, working closely with relevant stakeholders to ensure fair and accurate outcomes.

• Process Improvement:

  Continuously identify opportunities to enhance the claims processing workflow, implementing efficiencies without compromising quality or compliance.

• Training & Mentorship:

  Provide ongoing training and mentorship to the claims processing team, enhancing their medical and policy evaluation skills.

Required Skills:

• MBBS

  qualification from an Indian institution.
• Strong medical acumen to evaluate treatment appropriateness and medical documents.
• Ability to manage and lead a team responsible for processing claims.
• Proficiency in making decisions based on policy guidelines and medical assessments.
• Excellent analytical and problem-solving skills for claim evaluation.
• Strong communication and interpersonal skills to interact with team members and stakeholders.
• High level of attention to detail and commitment to accuracy.