Role Summary:

We are looking for a driven Claims Manager to lead the Reimbursement Claims department, overseeing end-to-end claim operations, TAT adherence, insurer coordination, and process governance. This role is ideal for a high potential graduate from a premier engineering institute (IIT / NIT / BITS) with 1-2 years of experience, looking to build a career in health insurance operations and claims management. The ideal candidate combines robust analytical rigor with hands-on process ownership, building and enforcing SOPs that scale claim operations across corporate accounts.

Key Responsibilities:

- Department Management: Manage the end-to-end Reimbursement Claims department, overseeing daily claim volumes, team productivity, and overall operational output.
- TAT Adherence: Own and monitor claim adjudication turnaround times (TAT); design and enforce controls to ensure claims are processed within defined SLAs across all corporate accounts.
- Insurer Coordination: Serve as the primary point of contact for insurer partners; drive resolution of adjudication queries, escalations, and reconciliation discrepancies.
- SOP Setup & Process Governance: Design, document, and implement SOPs for claim intake, adjudication, escalation handling, and debit note issuance; drive continuous process improvement.
- Escalation Management:



Own critical AM and insurer escalations; ensure timely root-cause analysis and permanent resolution to prevent recurrence.
- Team Leadership: Lead, mentor, and performance-manage a team of claims specialists and team leads; set OKRs and track individual and team performance.
- Reconciliation & Reporting: Ensure accurate daily, weekly, and monthly claim reconciliation; present operational MIS and dashboards to leadership.
- Cross-functional Coordination: Partner with Product, Tech, and Vendor Management teams to drive automation and system improvements in the claims workflow.

Qualifications:

- B.Tech / B.E. or equivalent degree preferrably from a premium institute

- 1-3 years of professional experience (any industry)

- Proven experience in managing or mentoring team

- Prior exposure to operations, analytics, or process driven roles preferred

- Health insurance / TPA / claims background is a plus, not mandatory

Skills Required:

- Strong analytical and problem-solving skills

- Process design and SOP documentation

- Advanced Excel / data analysis

- Stakeholder and insurer coordination

- Team leadership and performance management

- Ownership mindset with bias for execution

📌 Claims Reimbersement Manager (Bengaluru)
🏢 Medibuddy
📍 Bengaluru