Job Summary

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, Offroll/ Part time 4000+
- Function Workforce Number: On Roll 800, Offroll/ Part time 279
- Department Workforce Number: On Roll 69, Offroll/ Part time 66
- Other Quantitative and Key Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter
Job Context

Major Challenges: To ensure Quality in the claim process and audit, managing TAT as per agreed SLA
Key Result Areas

Key Result Areas (Max 1325 Characters)

Supporting Actions (Max 1325 Characters)
- 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 TCs, Time management, Delegation
- Strong 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;

1. LDR report monitoring
2. Daily intimation reports
3. Monthly MIS check For TAT
4. OPD FWA Savings data

DN monitoring for check pts
- Debit note supervision for all the payments from TPAs OPD Partners Viz.

1. DOA should not be empty
2. Future date of admission should not be mentioned.
3. Date of discharge
4. Policy start

📌 DM- CRM Claims professional (Thane)
🏢 Aditya Birla Insulators
📍 Thane