Sriyah Insurance Brokers Pvt. Ltd.
Website:
sriyah.in
Job details:
About the Role
We are looking for an experienced and customer-focused Manager – Health Claims to manage and oversee health insurance claims operations in an insurance broking environment. The role will be responsible for ensuring timely and efficient claim resolution, coordinating with insurers, TPAs, hospitals, clients and employees, and maintaining high standards of service and compliance.
Key Responsibilities
Health Claims Management
- Manage the end-to-end health insurance claims process, including cashless and reimbursement claims.
- Review and monitor claims to ensure timely processing and resolution.
- Coordinate with insurance companies, TPAs and hospitals for claim approvals, queries, documentation and settlements.
- Handle escalated and complex claims and ensure appropriate resolution within defined timelines.
- Monitor pending, rejected, repudiated and disputed claims and drive them towards closure.
- Review claim-related documents and identify discrepancies, exclusions, policy limitations and other relevant issues.
- Assist clients and employees in understanding claim procedures, policy benefits and documentation requirements.
- Ensure claims are handled in accordance with policy terms, insurer guidelines and applicable regulatory requirements.
Client & Relationship Management
- Act as a key point of contact for corporate clients on health claims-related matters.
- Build strong relationships with clients, insurers, TPAs and healthcare providers.
- Understand client requirements and provide timely solutions to claims-related concerns.
- Conduct regular claims reviews and provide clients with updates on claim trends, pending cases and key issues.
- Handle client escalations professionally and ensure timely closure.
Key Performance Indicators (KPIs)
- Claims turnaround time and SLA adherence
- Pending and ageing claims
- Claim resolution and closure rate
- Escalation resolution time
- Client satisfaction and service quality
- Team productivity and performance
- Accuracy of claims processing and MIS
- Effective coordination with insurers and TPAs
- Reduction in unresolved and disputed claims
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