General Manager - Claims

Job Responsibilities:

Troubleshooting and support in case of any cashless issues, escalated by Zones / C.O.

Negotiations during cashless process and post cashless settlements, recoveries, if any, escalated by Zones /C.O.

Market Intelligence - Hospital frauds, Pricing structure with other Insurers, Ethical practices or absence of it, of the Hospitals, periodic interaction with marketing teams and gathering of feedback on hospitals. Timely feedback to the CVO (or his nominee) on need for further investigation on fraud noted.

Non-ANH to ANH Conversion Activity, review of frequently occurring surgical procedures in the existing ANH hospitals which are not included in the list of agreed packages, and their inclusion on an ongoing basis.

Hospital Portal usage for cashless, submission of documents through portal for post cashless settlement - coordination and imparting necessary training.

To support and facilitate resolution of issues faced by FVO.

Ascertaining and updating in PMS, name and contact number

o Key Personnel like Medical Administrator, MRD In-charge and Insurance Desk In-charge.

o Persons with whom negotiations can be entered into while handling cashless

Taking up of issues faced by Hospitals, including TDS related and hospital payment related communications from Hospitals to C.O. and Vice Versa.

Change and updating - Discount entry, Basic details, NEFT, PAN, Name of Hospital, Address, Contact details - for uploading in PMS portal by EPPM Department.

Training of Front Office Personnel of Hospitals.

Organising Progress through Synergy meetings.

In Person Verification and Validation of Infrastructure verified by COVIT Team of EPPM - As and when instructions are sent by CFM Department.

Negotiate with the hospitals on pricing, as per the requests/ advise/demand from EPPM.

Star Health is a business organisation and hence the performance assessment of HRMs will be based on their actual contribution to the savings of the company and in preventing losses.