Claims Manager Job Vacancies in Mumbai

Job profile: To ensure to publish MIS, Regulatory Data submission, Analysis on periodic basis with effective controls built in and allied activities by overcoming system and infrastructure constraints. To identify trends, alert and suggest strategies towards risk/fraud mitigation strategies and policies within the framework of Compliance/ Groups Policies. To identify and prevent regulatory breach of Claims TATs, and timely data submission by overcoming challenges related to systems and infrastructure, using manual methods where required. Accurate and timely submission of periodic and ad-hoc reports related to Claims to the Regulatory Authority/GI Council Audits: IRDA, Internal, Stat, others Data submission/query response/ad-hoc reports to IRDA/GI Council Closure of audit observations Monthly / Quarterly / Annual Data submission Policyholders protection committee, Quarterly board meetings, monthly Ops Review, Weekly Claims Review Develop, Implement shortcuts, macros, formulae on excel, using alternative tools/methods for timely submission Develop, train the team, delegate and review their accountability Do cursory/sanity check before submission Team training, Time management, DelegationStrong coordination skills with other departments, sharp and on the spot thinking, proactive approach, soft skills, excel skills, working with other tools/macros Work closely with Finance, Actuary, Operations, Internal Claims team. To decide on complex claims, reconsideration claims and claims beyond the authority of the Claims Department To decide on complex claims, ex-gratia claims, reconsideration claims and claims beyond the authority of the Claims Committee Business forecast, MIS, query resolutions etc. Claims status, query resolutions, MIS System issues, queries, testing and system developments/ enhancementsTechnical skills: Reimbursement claims, MIS , Insurance, health insurance, medical insuranceSoft skills: Team leader

Job profile: Accurate and timely submission of periodic and ad-hoc reports related to Claims Trainings to the partner claim processors regarding policy T&Cs, Time management, Delegation Debit note supervision for all the payments from TPAs & OPD Partners Viz. Coordinating with Partner leadership teams /tech teams for MVP implementations viz In health check-ups utilization should be driven towards home collection instead of hospitals. FWA investigations are to be conducted in the agreed percentage of claims. (Partner end) The reimbursement claims adjudication rule engine (automated) should be aligned with the company process Real time client Dashboard for client reviews. Query management Medicos to process OPD claims Maintain daily MISTechnical skills: Reimbursement claims, MIS , Insurance, health insurance, medical insuranceSoft skills: Good communication skills, leadership skills, interpersonal skills, analytical skills, , interpersonal skillsEducational Qualification: Any GraduateExperience: 2 or more years of relevant experience in insurance or third party administrator