Description

We are seeking a talented and experienced skilled to join USGI Legal Entity's Health & Travel Claims department as a Manager. In this role, you will oversee and manage the health claims processing function, ensuring optimal performance and compliance with regulations. Your expertise will be crucial in driving efficiency, cost-effectiveness, and maintaining strong relationships with internal and external stakeholders.

Responsibilities

- Oversee daily health claims processing operations, ensuring timely and accurate adjudication.
- Implement and enforce TPA governance guidelines and insurer audit protocols for all claims.
- Develop and execute cost-effective strategies to enhance claim processing efficiency and profitability.
- Analyze claim processing data, identify trends, and implement process improvements for cost reduction.
- Collaborate with cross-functional teams to resolve complex claim issues and ensure regulatory compliance.
- Stay updated on industry trends, implement innovative solutions, and ensure data privacy and security.
- Prepare and present regular reports to senior management,



providing insights and recommendations.
- Manage stakeholder relationships with insurers, TPAs, and business partners.
- Ensure compliance with all applicable regulatory and compliance requirements.

Qualifications

- Bachelor's degree in ,MBBS, BDS, BAMS, BHMS.
- Minimum 5 years of experience in insurance related domains
- In-depth knowledge of TPA governance, insurer audit processes, and cost management strategies.
- Strong analytical skills for data interpretation and process improvement.
- Excellent communication and interpersonal skills for effective team collaboration.
- Proficiency in claim processing software and MS Office applications.
- Ability to work independently, manage multiple tasks, and make sound decisions.
- Problem-solving skills and a proactive approach to resolving complex claims.
- Flexibility to adapt to changing industry regulations and requirements.
- A passion for continuous improvement and a commitment to delivering exceptional services.

📌 Manager – Health Claims Processor (Maharashtra)
🏢 Universal Sompo General Insurance
📍 Maharashtra