Manager - Health Claims

Role Overview: You will be responsible for applying medical knowledge in evaluating the medical claim files to ascertain the medical admissibility. It is essential to understand the policy wordings including Terms & conditions to adjudicate the Admissibility/Rejection. Additionally, you will be processing claims as per regulatory guidelines, adhering to the TATs in processing, conducting quality reviews of processed files, handling grievance redressal and escalations, and identifying fraudulent claims. This is a work-from-office role on a roster basis. Key Responsibilities: - Apply medical knowledge in evaluating medical claim files - Understand policy wordings including Terms & conditions - Process claims as per regulatory guidelines - Adhere to TATs in processing - Conduct quality reviews of processed files - Handle grievance redressal and escalations - Identify fraudulent claims Qualifications Required: - Medicos only - BAMS and BHMS - Candidates with clinical experience preferred - Candidates with TPA & Insurance experience will be considered - Freshers are also eligible to apply Please note that this role is open for candidates who have not been interviewed in the last 6 months. Candidates with the mentioned qualifications will only be considered. If you are excited to be part of a team dedicated to innovation and excellence, please submit your resume by applying to this job. Join Tata AIG, where your skills and ambitions can thrive.,