Senior Manager

Job Summary:

The position will involve claims analysis and processing facilitation in coordination with different TPA’s and Insurance companies.

Responsibilities:

• Leading team and reduce escalations to the maximum extent possible.
• Managing relations with TPAs/Insurers to ensure claims SLA is maintained.
• Interacting with client HRs to resolve their claims related queries, if required.
• Explaining clients on the policy terms related queries over the call or mail.
• Reviewing denial claims sent by TPAs & ensuring that denial is done as per policy terms.
• Representing client claims to insurer/TPA in case of ambiguity in settlement/denial
• Supporting Analytics team in data analytics.
• Managing the assigned team members day to day activity & their productivity to ensure excellent client experience.
• Visiting insurer office whenever required to get the necessary approvals on claims.
• Supporting client servicing teams in claims related issues whenever required.

Desired profile/who should join:

• Should be a graduate with any specialization.
• Should have 10-15 years of experience in Managing EB Claims teams processing (Cashless/Reimbursements)
• Good knowledge about the TPA/Insurance processes
• Well verse with health insurance policy conditions
• Well verse with current medical practices & advancements
• Should have knowledge about IRDA health regulations
• Good communication skills
• Problem solving attitude
• Team leading
• Mentoring Skills
• Decision making
• Good team manager