Job Purpose

To role is required to manage Claims Payments of Indemnity Fixed Benefit Claims; within specified TAT as per IDRA Guidelines
Dimensions
- Business Workforce Number (Max 254 Characters)
- Unit Workforce Number (Max 254 Characters)
- Function Workforce Number (Max 254 Characters)
- Department Workforce Number (Max 254 Characters)
- Other Quantitative and Significant Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter
- Business KPI TAT
1. In House Processed Claims
1. Pre Auth Process 2 hrs (Approval / Denial / Response / Query)
2. Reimbursement Claims 5 working days
3. Claims Processing TAT 7 days
4. Grievance Resolution 15 working days
5. Monitor Maintain ACS as per Benchmark Cashless / Reimbursement / Combined
6.



Claim Approval Denial basis the Claim Approval / Denial Authority Matrix defined
1. TPA processed Claims
1. Pre Auth Approval 30 mins
2. Pre Auth Reimbursement Claims Denial
1. QC Claims Audit
2. Periodic Audit of Paid Claims processed by TPAs
1. Claims System Development
2. Requirement Gathering, Support for System Development requirement

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📌 TL-Cashless Claims professional (Hyderabad)
🏢 Aditya Birla Insulators
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