23 Oct
|
Career Shaper
|
Thane
23 Oct
Career Shaper
Thane
Role: Claims Operations
Industry: Insurance (General / Health / TPA)
Location: Thane
Experience: 0 to 10 Years
Role Overview
We are hiring a Claims Operations Specialist/Manager to lead end-to-end adjudication, quality governance, and audit workflows across Health, Personal Accident (PA)
Key Responsibilities
- Manage end-to-end Indemnity (Cashless & Reimbursement) and Fixed Benefit claims processes.
- Ensure strict adherence to TAT benchmarks, adjudication accuracy, and approval authority limits.
- Conduct regular audits for both In-House and TPA claims decisions to ensure regulatory compliance.
- Lead and mentor claims adjudication teams; drive uniform quality standards.
- Analyze portfolio metrics: loss ratios, combined ratios, frequency/severity, and medical inflation.
- Refine claims SOPs, mitigate exposure risks, and drive continuous process improvements.
📌 Claim Processor (Thane)
🏢 Career Shaper
📍 Thane