Deputy General Manager - Claims

Job Description

Key Responsibilities: 1. Departmental Administration Monitoring Oversee the daily operations of the Field Verification and Risk (FVR) department, ensuring smooth workflow and adherence to standard protocols. Monitor productivity, attendance, and performance of the FVO team. 2. Field Verification Process Fraud Detection Allocate surprise visit assignments to zonal teams based on daily intimation reports. Analyze FVR claim savings and validate cost reductions due to fraud identification. Review and escalate suspicious or fraudulent hospital reports (both Network Non-Network) to hospital chairs for necessary actions. 3. Quality Assurance Performance Review Conduct daily reviews of FVO productivity and engage with underperforming team members for corrective action. Analyze and review Quality Analysis reports and discuss findings with relevant FVOs. Ensure accurate review of hotspot area call verification reports, particularly in locations without active FVOs. 4. Training Mentorship Organize periodic meetings with Pan India FVO teams to conduct: Training sessions on fraud detection and claim verification techniques. Productivity and quality review discussions. Ensure TAT is consistently maintained above 95%. Provide specialized training to ZO executives and FVOs in high-ICR branches and hotspot areas on suspicious claims and fraudulent hospital identification. 5. Inter-Departmental Coordination IT Liaison Ensure effective collaboration with IT and FVR teams for resolving system-related issues raised by FVOs and ZO executives. 6. Stakeholder Management Reporting Conduct field visits to critical zones for direct engagement with FVOs and ZO executives. Prepare and present reports on fraud trends, claim savings, and operational improvements to senior leadership. --- Required Skill Set: 1. Administrative Leadership Skills Strong ability to lead and manage a large team across multiple locations. Experience in handling interdepartmental coordination and decision-making. 2. Fraud Detection Quality Assurance Expertise in claims fraud analysis, auditing, and verification procedures. Ability to review and analyze FVR claim savings and suspicious cases. 3. Mentorship Training Experience in mentoring field verification teams and conducting structured training programs. Ability to develop and implement fraud detection training modules. 4. Data Analysis Reporting Strong analytical skills to evaluate claim trends, fraudulent patterns, and operational reports. Proficiency in data-driven decision-making and performance tracking. 5. Team Management Productivity Enhancement Experience in managing field teams, ensuring operational efficiency, and driving performance improvements