1) Job Purpose: Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)
The purpose of this role is to plan, establish and supervise the MIS function of Claims. This includes ensuring accurate and timely submission of periodic and ad-hoc reports related to Claims to the Regulatory Authority, handling Audits (IRDA, internal audits and other audits), preparing the claims register, bring in process improvements, automation, publishing analytical reports / Claims MIS and daily dashboard.
The purpose involves Data Support and inter-department coordination with all stakeholders including sales, finance, internal claims and actuary teams.
2) Dimensions: Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job.
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Unit Workforce Number
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Function Workforce Number
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Department Workforce Number
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Other Quantitative and Significant Parameters for the job: Budgets/ Volumes/No.
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Prepare and Publish Claims MIS
- Regulatory Submissions: Accurate and timely submission of periodic and ad-hoc reports related to Claims to the Regulatory Authority/GI Council
- Handling Audits - (IRDA, internal audits)
- Complete ownership of handling all audits in the Claims function – IRDA, Internal, Statutory, Concurrent and Retrospective
- Data submission/query response/ad-hoc reports to IRDA/GI Council
- Ensure proper closure of audit observations
- Publish Dashboards
- Claims TATs: Cashless, Reimbursement – in house & TPA periodically
- Analytics – Claims trends and Apprise/Alert the relevant stakeholders
- Publish Daily/weekly/monthly dashboards related to Claims Intimations, TAT, NPS, Settlement Ratio, Average Claim size, Productivity, Pendency, Digital metrics