Digit Insurance
Website:
godigit.com
Job details:
Job Description
Team Lead – DV
Department: Health
Sub-Department: Health Claims
Grade: G3C
Reporting To: Head – Health Claim Operations
Prepared By: HRBP
Consulted With: Lead – DV
Position Description
The Lead – DV is responsible for managing end‑to‑end health insurance claims operations for the DV function. This role involves leading a team of claims associates, ensuring accuracy, compliance, and timely claim processing while consistently meeting SLAs and quality benchmarks. The role also serves as a key point of escalation, drives continuous process improvement, and collaborates with TPAs, hospitals, and internal stakeholders to ensure smooth and compliant claim operations.
Key Responsibilities
- Lead, mentor, and support a team of claims associates to drive productivity, accuracy, and SLA adherence.
- Oversee correct registration, triaging, and processing of health insurance claims as per policy terms, SOPs, and internal guidelines.
- Ensure compliance with IRDAI regulations, internal control frameworks, and audit standards.
- Review complex claims and handle escalated customer or provider issues to ensure timely and effective resolution.
- Monitor claim quality and documentation standards, ensuring complete, accurate, and clear case notes in the system.
- Support MIS and reporting by identifying and highlighting trends related to pendency, rejections, rework, and repeat issues.
- Identify operational gaps and contribute to process improvements to enhance efficiency, accuracy, and customer experience.
- Coordinate with TPAs, hospitals, and cross‑functional internal teams to address operational dependencies and resolve issues.
Experience
Experience & Skills Required
- 8–15 years of experience in health insurance or TPA operations.
- Prior experience in claims processing or pre‑authorization operations is required
- Experience handling provider queries, escalations, and medical documentation review
Technical Skills
- Strong understanding of health insurance claims processes, policy interpretation, and SOP adherence.
- Familiarity with regulatory requirements, including IRDAI guidelines.
- Ability to analyze claim trends and operational data for MIS and reporting.
- Working knowledge of claims management systems and workflows.
- Proficiency in MS Office tools.
Behavioral Skills
- Attention to Detail
- Effective Communication
- Collaboration and Stakeholder Management
- Ownership and Problem Solving
Qualifications
- Graduate degree in any discipline.
- No specific academic stream required.
- No mandatory certifications.
What You Bring to Digit
- Proven leadership capability in managing claims teams and operational performance.
- Strong decision‑making skills with a balanced focus on compliance and customer experience.
- Ability to drive accountability, coach teams, and manage escalations effectively.
- A continuous improvement mindset with the ability to identify risks and streamline processes.
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