01Overview
Role Overview
Claims lead for the corporate claims vertical. To manage the entire corporate Claims team and oversee end-to-end claims operations. This role is critical in ensuring our corporate partners and their employees receive a seamless, claims experience. You will be responsible for driving operational excellence, maintaining Evens quality standards, and leading a high-performing team in a fast-paced, digital-first environment.
Key Responsibilities
As the lead, your core responsibilities will include:
Monitoring Claims: Closely supervising the end-to-end lifecycle of OPD and wellness claims to ensure accuracy and compliance.
TAT Maintenance: Taking full ownership of the team's Turnaround Time (TAT) to ensure claims are processed swiftly, reliably & within the.
Time Adherence: Managing team schedules and workflow to ensure consistent operational coverage and productivity.
Daily Targets: Setting and driving the team to meet daily throughput goals while maintaining high quality benchmarks.
Escalation Handling: Acting as the primary point of contact for complex B2B claim disputes, ensuring professional and timely resolutions.
Conduct regular quality audits, feedback sessions, and team coaching.
Identify operational gaps, fraud indicators, and process improvement opportunities.
Ensure compliance with internal policies, audit requirements, and regulatory guidelines.
Support hiring, onboarding, and training of current team members.
Requirements
6+ years of experience in claims processing, health insurance, TPA operations, or healthcare operations.
Prior team handling or leadership experience required.
Strong understanding of medical terminologies, OPD claims, and health insurance processes.
Experience managing high-volume claims operations in a quick-paced environment.
Robust analytical, problem-solving, and stakeholder management skills.
Excellent communication, team management, and operational coordination abilities.
Hands-on experience with CRM or claims management systems.
Preferred qualifications- MBBS, BDS, BHMS, BAMS, Nursing or B Pharm. .
