GM/AVP - Quality Management and L&D

Design and deliver structured training programs for Financial and Medical claims processing teams. Develop claims curricula, SOPs, job aids, and refresher modules aligned with regulatory and company standards. Creation, periodic review and update of claims quality management plan Sample based review of medical and financial adjudication to identify errors and plan mitigation To ensure existence of a no critical error and minimal non-critical error process. Coordinate with internal audit team to plan and execute periodic claims audit Run clinical governance across all functions housing clinical experts. Implement and manage claims quality assurance frameworks, audits, and root cause analysis. Monitor claims accuracy, compliance, turnaround times, and customer impact metrics. Partner with Operations, Medical, Finance, Compliance, and Technology teams to address quality gaps and process improvements. Drive continuous learning initiatives, certifications, and upskilling for claims professionals. Track training effectiveness and quality outcomes using KPIs, dashboards, and reporting. Key

Prefer MBBS Graduate/Postgraduate in Healthcare, Insurance, Finance, or related field 812 years of experience in Health Insurance Claims, with exposure to Training and Quality functions Strong understanding of Health Insurance claimsFinancial and Medical Expertise in Claims Quality Management and Audit Processes Learning & Development / Training Design experience Knowledge of regulatory and compliance standards Analytical, stakeholder management, and communication skills .