01Overview
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) .
