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Job Purpose
- Knowledge of Claims processes: Indemnity (Cashless, Reimbursement), Fixed Benefit Products
- Understanding of Claims systems (process flow & System fields) – Health, PA & Travel
- Experience in measurement of performance (TAT, accuracy in claims adjudication)
- Expectations management of the Claims team
- TAT & expectations management for specialized business handling.
- Ensure uniformity in quality & maintain TATs of Claims decisions
- Create & maintain standards/protocols for Claims team
- Audit claims decisions in adherence & compliance with the Claims guidelines, uniformity in decisions, and approval authority limits (In house and TPA claims)