- Monitor Network and reimbursement claim settlement.
- Ensure the claims are processed within the agreed TAT as per Insurer SLA
- Establish claim adjudication guidelines and governance frameworks.
- Monitor TPA performance against SLAs as per Metrics.
- Follow up monthly operational reviews with MIS team.
- Coordination with Insurer on daily basis for Rejection and approval claims
- Resolve service issues and escalations from Insurer.
- Ensure compliance with insurer guidelines.
- Preparing reports