01Key Responsibilities
Insurer & Internal Query Management: Act as the primary contact for insurer communications and internal support queries. Ensure timely resolution of escalations and claim-related issues.Claims Processing Reimbursement & Cashless: Manage end-to-end processing of reimbursement claims, including documentation, validation, and settlement. Generate and send cashless debit notes to insurers and follow up for approvals and payments.Insurer Relationship Management: Maintain strong working relationships with insurers (Health or General Insurance).Coordinate regularly to address claim-related issues and streamline processes.TAT Monitoring & SLA Compliance: Monitor claims turnaround time (TAT) and ensure compliance with internal and external SLA benchmarks. Identify delays or inefficiencies and implement corrective actions to improve process efficiency.Reporting & Process Improvement: Prepare regular reports on claims performance, TAT, and issue trends. Recommend and support initiatives for process enhancement and operational excellence.
Experience & Qualifications:
Experience: 45 years in Claims Handling or Insurance Operations
Industry Background: Experience with Insurance Companies or Third Party Administrators (TPAs)
Preferred - Exposure to Health or General Insurance is highly desirable
Education: Bachelor's degree in any discipline (preferred: Insurance, Healthcare, or Business Administration)Skillset:
In-depth knowledge of reimbursement and cashless claim processesStrong relationship management and coordination skillsFamiliarity with TAT and SLA monitoringProficiency in MS Office and claims management systemsStrong communication, analytical, and problem-solving skills .
