Manager - Health Claims

About the Company

Claim Assessment & Processing: Evaluate claims (cashless/reimbursement) as per policy terms, medical documents, and regulatory guidelines, ensuring accurate adjudication.

About the Role

Coordination & Communication: Liaise with TPAs and internal teams; issue queries, approvals, and repudiation communications in a timely to TPA & Customer.

Responsibilities

• Compliance & Documentation: Ensure adherence to SOPs, IRDAI norms, and maintain complete audit-ready documentation with proper record of all claim actions.
• Quality & TAT Management: Process claims within defined turnaround time as per regulatory & internal guidelines while maintaining high accuracy and minimizing errors or rework.
• Issue Resolution & Escalation Handling: Address discrep...