To efficiently process and manage assigned claims within defined productivity and quality standards while ensuring accuracy, compliance, and minimum financial errors. The role will focus on achieving productivity targets, maintaining high-quality claim processing, reducing short-paid cases, and continuously improving SF% through accurate assessment and adherence to established processes and guidelines.
Key Responsibilities
1. Productivity & Claims Processing 50%
- Process assigned claims within defined productivity and turnaround time requirements.
- Achieve daily, weekly, and monthly productivity targets as per the defined benchmarks.
- Maintain consistent productivity without compromising processing accuracy and quality.
- Prioritize cases based on business requirements, TAT, complexity, and ageing.
- Monitor individual productivity against assigned targets and identify areas for improvement.
- Ensure timely completion and closure of assigned cases.
- Maintain accurate records and update claim status in the relevant systems.
- Support the team in achieving overall operational productivity targets.
2. Quality & Concurrent Audit 10%
- Process claims accurately in accordance with defined policies, SOPs, and operational guidelines.
- Ensure zero financial errors in claim processing.
- Review claim details, eligibility, deductions, calculations, and supporting documents before final processing.
- Understand and address observations raised during concurrent audits.
- Analyze recurring errors and implement corrective measures to prevent repetition.
- Maintain a high level of accuracy while meeting productivity targets.
- Ensure adherence to internal controls and financial approval guidelines.