Manager Health Claims Raigarh

Job Description About the Company n Claim Assessment & Processing: Evaluate claims (cashless/reimbursement) as per policy terms, medical documents, and regulatory guidelines, ensuring accurate adjudication. n About the Role n Coordination & Communication: Liaise with TPAs and internal teams; issue queries, approvals, and repudiation communications in a timely to TPA & Customer. n Responsibilities n n Compliance & Documentation: Ensure adherence to SOPs, IRDAI norms, and maintain complete audit-ready documentation with proper record of all claim actions. n Quality & TAT Management: Process claims within defined turnaround time as per regulatory & internal guidelines while maintaining high accuracy and minimizing errors or rework. n Issue Resolution & Escalation Handling: Address discrepancies, investigate suspicious cases, and escalate critical matters promptly to ensure effective resolution. n n Qualifications n BHMS; MBBS .