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 solid 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 cutting-edge 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