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
DOA should not be empty
Future date of admission should not be mentioned.
Date of discharge
Policy start date should not be blank
Policy end date should not be blank
Policy end date
Policy start date > Date of Intimation
Date of Admission should be falling within Policy period
Paid amt > Claimed Amt
Paid d

📌 Tm Reimbursement Claims Professional Thane
🏢 Aditya Birla Insulators
📍 Thane