Description
We are excited to welcome a talented and experienced qualified to join the USGI as Manager – Health Claims. In this role, you will be responsible for leading the end-to-end health claims processing function, ensuring timely, accurate, and compliant claim adjudication while maintaining high standards of customer service. You will oversee daily claims operations, ensure adherence to TPA governance protocols, insurer requirements, and audit standards, and drive process efficiency across the claims lifecycle.
The role will play a critical part in managing TPA operations, including oversight of TPA-processed claims, ensuring adherence to agreed service levels, governance frameworks, and performance metrics. You will be responsible for driving TPA governance, conducting reviews of claims processes, and ensuring compliance with insurer requirements, contractual obligations, and regulatory guidelines.
A key aspect of this position involves cost management and claim optimization, leveraging data-driven insights and effective controls to manage claim costs, minimize leakage,



and enhance operational efficiency. You will also ensure adherence to all applicable regulatory and compliance requirements, maintaining robust controls and governance across claims operations.
The role requires strong focus on grievance management and resolution, ensuring customer complaints and escalations are addressed promptly and effectively. You will collaborate closely with internal and external stakeholders, including insurers, TPAs, intermediaries, and business partners, fostering strong relationships and ensuring alignment on operational and service delivery objectives. Through effective stakeholder management, intermediary engagement, operational oversight, and process enhancement initiatives, you will contribute significantly to improving claims outcomes, strengthening partner relationships, and achieving the organization's strategic goals.

Responsibilities
- Oversee daily heal

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