Senior Manager-Claim Clinical Strategy & Cost Management
Bajaj General Insurance
- Location
- Moradabad, Uttar Pradesh, India
- Job type
- Full-time
Required skills
- compliance
- strategic projects
About the role
Website:
bajajgeneralinsurance.com
Job details:
- Cost Management
- Enabling team to train on financial risk management and mitigation
- Creating framework for Reduction of financial errors in claims processing (4-eye principle).
- Creation of Protocol for disease and Ensure the Execution.
- Leading case management to create savings.
- Correct Data Validation
- Right capturing of Internation disease coding and Procedure coding
- CRC (compliance audits)
- Supporting analytics team with audit insights and data.
- SOP creation and updation
- Right communication to be created based on life cycle of claim
- Training & Knowledge Management
- Develop medical terminology and medical training programs.
- Create case studies based on identified errors to prevent recurrence.
- Training of team on Protocols and proper execution so that there is no leakage
- Strategic Projects & Automation
- Create a Decision Support System (DSS) for the top 50 most common medical conditions.
- Drive the incorporation of AI-based systems (e.g., Vitraya, Niriksha for automated decisioning.
- Develop and support Excel Macros for rejection clauses and internal audit streamlining
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