Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD
Business
Health Insurance
Unit
Aditya Birla Health Insurance Company Ltd
Location
MBC, Thane
Poornata Position Number of the job
Reports to: Poornata Position Number
Poornata Position Title of the job (30 characters max)
TM-Mrg-Claims-3-Thane
Reports to: Poornata Position Title
Head – Reimbursement/Cashless Claims
Function
Services Operations
Reports to: Function
Services Operations
Department
Ops - Claims
Reports to: Department
Ops – Claims
Designation of the Employee
Team Lead - Claims
Designation of the Manager
Associate VP
Date of writing/updation of JD
20th July 2021
1) Job Purpose: Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)
To role is required to manage Claims Payments of Indemnity & Fixed Benefit Claims; within specified TAT & as per IDRA Guidelines
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.
Business Workforce Number
(Max 254 Characters)
Unit Workforce Number
(Max 254 Characters)
Function Workforce Number
(Max 254 Characters)
Department Workforce Number
(Max 254 Characters)
Other Quantitative and Key Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter
Business KPI & TAT
- In House Processed Claims –
- Pre Auth Process - 2 hrs (Approval / Denial / Response / Query)
- Re-imbursement Claims – 5 working days
- Claims Processing TAT – 7 days
- Grievance Resolution – 15 working days
- Monitor & Maintain ACS as per Benchmark – Cashless / Re-imbursement / Combined
- Claim Approval & Denial basis the Claim Approval / Denial Authority Matrix defined
- TPA processed Claims –
- Pre Auth Approval - 30 mins
- Pre Auth & Re-imbursement Claims Denial
- QC & Claims Audit –
- QC of claims processed in In-House ABHI Syst