Key Responsibilities
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