Job Description:

Primary Role Description: The individual will head reimbursement claims process (Claim reporting to final decision). He / She will play a key leadership role in driving Reimbursement claim strategy, managing the claims team, collaborating with other departments to ensure the organizational goals on finances, customers, processes and people are met.

Key Roles & Responsibilities:
- Leadership and Management:
- Lead and manage the health claims team of 135 people to ensure optimal performance and efficiency in the claims adjudication process.
- Set objectives, provide training, and coach the team to meet departmental goals and KPIs.
- Foster a collaborative workplace between the claims department and other internal departments, such as underwriting, customer service, and sales.
- Ensure that the team remains compliant with internal policies, industry standards, and government regulations
- Claims Process Management:
- Supervise and streamline the end-to-end health reimbursement claims process, ensuring claims are processed in a timely, efficient,



and accurate manner.
- Implement and refine processes for claim adjudication, coding, and payment, ensuring compliance with healthcare standards (e.g., ICD codes, CPT codes).
- Oversee claim validations, review of medical documentation, and interaction with healthcare providers to resolve discrepancies
- Manage re-represented claims through Litigation processes
- Interact with key opinion makers in the industry for second opinion or to define and/or improve approaches and processes
- Develop and improve SOPs for key reimbursement processes
- Regular review of key KPIs and publication of report to key stakeholders
- Manage, review and govern all TPAs associated with the company for claims processes of group policies.
- Strategic Planning and Analysis:
- Help with and Implement strategies as decided by the management for improving claim accuracy, reducing claim processing times, and enhancing customer satisf

📌 Head – Reimbursement claims (Noida)
🏢 Mancraft Consulting
📍 Noida