Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD

Business

Health Insurance

Unit

Aditya Birla Health Insurance Company Ltd

Location

MBC, Thane

Poornata Position Number of the job

Reports to: Poornata Position Number

Poornata Position Title of the job (30 characters max)

TM-Mrg-Claims-3-Thane

Reports to: Poornata Position Title

Head – Reimbursement/Cashless Claims

Function

Services Operations

Reports to: Function

Services Operations

Department

Ops - Claims

Reports to: Department

Ops – Claims

Designation of the Employee

Team Lead - Claims

Designation of the Manager

Associate VP

Date of writing/updation of JD

20 th July 2021

Job Purpose: Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)

To role is required to manage Claims Payments of Indemnity & Fixed Benefit Claims; within specified TAT & as per IDRA Guidelines

Dimensions:



Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job.

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 Key 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)
Re-imbursement Claims – 5 working days
Claims Processing TAT – 7 days
Grievance Resolution – 15 working days
Monitor & Maintain ACS as per Benchmark – Cashless / Re-imbursement / Combined
Claim Approval & Denial basis the Claim Approval / Denial Authority Matrix defined
TPA processed Claims –
Pre Auth Approval - 30 mins
Pre Auth & Re-imbursement Claims Denial
QC & Claims Audit –
QC of claims processed in In-House ABHI Sys

📌 TL-Cashless Claims (India)
🏢 Aditya Birla Health Insurance Company
📍 India