Claims Manager

Role & responsibilities

• Verify documents, technical details, consumed amount, and hospital stay duration for claims.
• Keep claims pending for missing documents, recheck twice.
• Communicate with hospitals regarding pending cases and issue notices.
• Monitor fraudulent activities and ensure compliance with adjudication guidelines.
• Analyze and report claims data.
• Ensure claims settlement within TAT, scrutinize preauth claims.
• Respond to ETI and resolve repudiated claim appeals daily.
• Seek document compliance for discrepancies and inform hospitals.
• Cooperate with SHAS on medical queries and grievances.
• Attend SHAS and IC meetings, district visits, and conduct training.
• Coordinate with DMO, monitor doctor productivity, and specialists.
• Handle stakeholder communications.