This role is for one of the Weekday's clients

Salary range: Rs 400000 - Rs 800000 (ie INR 4-8 LPA)

Min Experience: 3 years

Location: Mumbai

JobType: full-time

This role involves overseeing end-to-end health claim processing with a strong focus on accuracy, timely decision-making, and compliance with policy terms and regulatory guidelines. The position requires evaluating claim documents, medical opinions, and risk indicators while ensuring seamless coordination with multiple internal and external stakeholders. The role also involves team leadership, process improvement, and the ability to handle escalations, complex cases, and high-volume operations across a Pan-India scope.

Key Responsibilities

- Manage end-to-end processing of health claims with strict adherence to turnaround times (TAT) and quality standards.
- Review claim documents, medical assessments, and policy terms to make accurate claim decisions.
- Conduct risk assessments and initiate verification procedures for suspicious claims.
- Collaborate with internal teams such as investigations, sales, product, legal, complaints, and external partners for smooth claim processing and escalations.
- Present case summaries, communicate with stakeholders, and represent cases to reinsurers when required.




- Ensure compliance with departmental SLAs and regulatory guidelines for claim processing.
- Lead, mentor, and guide team members and support their performance and development.
- Conduct reviews, provide feedback, and engage with stakeholders for continuous process improvements.
- Monitor emerging trends, market practices, and propose recommendations to senior management.
- Support weekend or second-shift operations as needed.
- Oversee team performance and ensure end-to-end TAT management for all health claims.

What Makes You a Great Fit

- Educational background in medical fields such as BAMS, BHMS, or BDS.
- Experience in insurance, particularly in health or life underwriting or claims.
- Robust understanding of insurance products and claim decision processes.
- Excellent analytical, presentation, and interpersonal skills.
- Proficient in MS Excel and Word, with the ability to multitask effectively.
- Strong attention to detail and the ability to maintain decision accuracy under pressure.
- Capable of managing teams and coordinating with diverse stakeholders across India.
- Commitment to quality, compliance, and continuous improvement in claims operations.

📌 Ass. Manager (Mumbai)
🏢 Recognized
📍 Mumbai