Vice President - Claims

Role & responsibilities

• Driving health claims strategy formulation and setting up processes for the function.
• Leading a team handling claims, customer queries & complaints, claim adjudication & registration, quality management, analytics etc..
• Formulating & ensuring claims/reimbursements settlements with superior TAT & customer experience.
• Analyzing incurred claim ratio, review of the portfolio & taking proactive action for loss control measures.
• Developing & implementing health claims fraud prevention & loss mitigation framework.
• Training & development of medical processors. Identifying key learning, gaps and opportunities for individuals to develop the team.
• Drive continuous improvement and assist team as and when vital to make the business run effectively and efficiently.
• Ensure that the highest possible levels of customer service are delivered at all the times

Preferred candidate profile

• Knowledge of healthcare / clinical domain
• Minimum 10 yrs or 7 yrs of TPA experience
• Knowledge of Indian health insurance systems and processes. Claims knowledge for health insurance of PSUs
• Health Insurance/TPA/ Hospital / Clinical Practice

Perks and benefits