Job Purpose

The purpose of this role includes ensuring coordination with the Service provider partner team for timely settlement of Travel and OPD claims. Candidate should be able to do regular medical and technical audits of the claims approved for settlement by the partner and should be able to maintain the MIS/Reports related to claims.
Dimensions

Business Workforce Number: On Roll 6000+

Offroll/ Part time 4000+

Unit Workforce Number: On Roll 6000

Function Workforce Number: On Roll 800

Offroll/ Part time 279

Department Workforce Number: On Roll 69

Offroll/ Part time 66
Job Context & Major Challenges

To ensure Quality in the claim process and audit, managing TAT as per agreed SLA
Key Result Areas
- Accurate and timely submission of periodic and adhoc reports related to Claims
- Develop, Implement shortcuts, formulae on excel, using alternative tools/methods for timely submission
- Do cursory/sanity checks before submission
- Closure of audit observations
- Trainings to the partner claim processors regarding policy T&Cs;, Time management, Delegation




- Robust coordination skills with other departments, sharp and on the spot thinking, proactive approach, soft skills, excel skills etc.
- Monthly / Quarterly / Annual Data submission
- Work closely with related stake holders (internal and external)
- Working on DATA / MIS
- Work closely with data teams of external stake holder for reports viz;
- LDR report & monitoring
- Daily intimation reports
- Monthly MIS check For TAT
- OPD FWA Savings data
- DN monitoring for check pts
- Debit note supervision for all the payments from TPAs & OPD Partners Viz.
- DOA and policy date controls
1. DOA should not be empty
2. Future date of admission should not be mentioned.
3. Date of discharge
4. Policy start date should not be blank
5. Policy end date should not be blank
6. Policy end date
7. Policy start date > Date of Intimation
8. Date of Admission should be falling within Policy period
9. Paid amt > Claimed Amt
10. Paid d

📌 TM-Reimbursement Claims Professional (Thane)
🏢 Aditya Birla Insulators
📍 Thane