Job Purpose

To role is required to manage Claims Payments of Indemnity Fixed Advantage 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
In House Processed Claims
Pre Auth Process 2 hrs (Approval / Denial / Response / Query)
Reimbursement Claims 5 working days
Claims Processing TAT 7 days
Grievance Resolution 15 working days
Monitor Maintain ACS as per Benchmark Cashless / Reimbursement / Combined




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

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