Senior Manager - Claims

We are seeking a dynamic and experienced Senior Manager- Claims to lead and manage the end-to-end claims process for our health insurance clients. The ideal candidate will have in-depth knowledge of TPA operations, hospital networks, policy terms, and regulatory guidelines, ensuring efficient and customer-focused claims management.

Industry: Health Insurance / TPA
Location: Anna Nagar, Chennai
Experience Required: 5 to 15 Years (TPA or Health Insurance industry experience mandatory)
Qualification: BHMS / BAMS / MBBS/ BDS

Preferable : Male candidate

Key Responsibilities:

• Supervise and manage the Claims Processing Team( Medical officer, Billing ) for cashless and reimbursement claims.
• Scrutinize and process hospitalization claims as per policy terms, conditions, and internal guidelines.
• Handle pre-authorization requests, case adjudication, and monitor turnaround time (TAT) adherence.
• Coordinate with empaneled hospitals for approvals, document collection, and query management.
• Ensure accurate and timely claim settlement and maintain compliance with IRDAI regulations.
• Conduct audits of claim files to check accuracy and identify areas for improvement.
• Resolve escalated cases and grievances from policyholders, hospitals, and insurance clients.
• Maintain MIS reports and data analysis for management review.
• Liaise with insurance companies and underwriters on claim-related matters.
• Regularly train and update team members on product changes, claim procedures, and compliance norms.

Interested candidate can share your updated resume to hr.vasanth@linkktpa.com

Company Profile

www.linkktpa.com

Job Type: Full-time

Pay: ₹50,000.00 - ₹65,000.00 per month

Benefits:

• Provident Fund

Schedule:

• Day shift

Education:

• Bachelor's (Required)

Experience:

• TPA / Health Insurance Company claims department: 5 years (Required)
• handling cashless & reimbursement claims, claims AUDIT : 5 years (Required)

Work Location: In person