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Manager - Claims - Health Insurance

5.00 to 8.00 Years   Bangalore   12 Jun, 2023
TalExel
Job LocationBangalore
EducationNot Mentioned
SalaryNot Disclosed
IndustryManagement Consulting / Strategy
Functional AreaGeneral / Other Software
EmploymentTypeFull-time

Job Description

    Manager - Claims - Health Insurance (8-12 yrs)Even within the healthcare space described above, the words Health Insurance claim are a shorthand for tons of paperwork, back and forth queries, lack of transparency and inordinate delays. Raising and processing a claim is an exhausting process for the patients, the hospitals and the insurance companies involved. This is an industry with a turnover of more than INR 50,000 Crores, but 95% of it is managed manually/traditionally.In-short, this is a large market waiting for systematic improvements and we are going to be the ones to bring about the change. We are looking for people who have an understanding of the current claim-evaluation processes of the industry, an open mind to imagine new and better ways and the perseverance to turn the vision into a reality. If you are one of them, then get in touch with us. This role involves driving all aspects of Health Insurance. The objective is to set new benchmarks in speed of claim processing, accuracy of adjudication and automation percentage. The Person (he/she) will have Strategic and tactical responsibility to plan and implement strategic goals to achieve key metrics such as Approval TAT, Shortfall/Rejection%, & customer NPS. The position reports to the Chief/Head of Processing Claims Insurance.Key Job Responsibilities:- Processing KYPs and discharges for reimbursement claims within TAT- Designing efficient, scalable and measurable processes and ensuring that those processes are complied with by the team.- Provide Medical opinion on any queries related to Health Insurance Claims.- Building scalable processes to process reimbursement claims with >99% accuracy- Manage volumes effectively & efficiently to maintain Turnaround time of processing cases both at the time of admission and discharge.Qualification:- Applicants must possess at least a graduation degree in BAMS / BHMS /MBBS etc. along with Masters in Hospital Administration/Health Management.Skills :- Excellent people management skills- Ability to use technology to improve outcomes- Good Excellent oral and written communication, negotiation and decision-making skills.- Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities.Experience :- At least 5-8 years experience in health claims processing.- Have prior experience of working in core Insurance companies,

Keyskills :
work effectivelyhealth insuranceinsuranceopen mind

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