Vice President-Claims

Role & responsibilities

• Driving health claims strategy formulation and setting up processes for the function.
• Leading a team handling claims, customer queries & complaints, claim adjudication & registration, quality management, analytics, etc.
• Formulating & ensuring claims/reimbursement settlements with superior TAT & customer experience.
• Analyzing the incurred claim ratio, reviewing the portfolio, & taking proactive action for loss control measures.
• Developing & implementing a health claims fraud prevention & loss mitigation framework.
• Training & development of medical processors. Identifying key learning, gaps, and opportunities for individuals to develop the team.
• Drive continuous improvement and assist the team as and when vital to make the business run effectively and efficiently.
• Ensure that the highest possible levels of customer service are delivered at all times.

Minimum Mandatory Qualification

MBBS

Minimum Mandatory Skill Set

Knowledge of healthcare / clinical domain

Experience (in years)

Minimum 10 years or 7 years of TPA experience

Desired Competencies / Skill Set

Knowledge of Indian health insurance systems and processes. Claims knowledge for health insurance of PSUs

Preferred Industry

Health Insurance/TPA/Hospital / Clinical Practice