Senior Manager - Medical Underwriting

A Position Overview

Position Title

Senior Manager

Department

Health Claims

Level / Band

Required knowledge of Health - for UW + Claims - Guidelines set up, Treaty checks ,Controls on I/S + Governance for claims

Role Summary:

Responsible for Health Underwriting and Health claims guidelines set up

Expertise in reviewing Treaty documents, medical opinions and understanding policy terms and conditions

Should have controls on I/S

Should be able to have governance for Claims

Team management

B Organizational Relationships

Reports To

Vice President

Supervises

C Job Dimensions

Geographic Area Covered

Pan India

Stakeholders Internal

FIU team, sales team, product team, legal team, complaints team

External

Customer/ Policyholder, Vendor- Prorisk/ Medi Assist

D Key Result Areas

Organization Process

Key Contribution

To ensure quality accuracy of Health Claim processes

Good knowledge on insurance products

Should have knowledge of Health underwriting and health claim

Ensure 100% quality completion of Claim decision

Ensure all processes of Health team are maintained by the department as per the specified inter intra department SLAs.

Presenting case summary and representing to reinsurers, communicating with distribution stakeholders

Ensure adherence to defined claims TAT decision accuracy

Mentor, guide train the entire team

Ensure quality accuracy of UW Claims process

Sharing feedback and conducting meetings with the relevant stakeholder s time to time

Evaluate emerging trends, competition practices and propose recommendations to senior management

Should be able to work on weekends and second shift

Managing the entire team and responsible for End to end TATs of Health claims as per regulatory guidelines

E Skills Required

Technical

Medical background- Education - minimum BAMS /BHMS/ BDS

Experience - insurance experience, life + Health UW/claims

Effective presentation and interpersonal skills.

Good system skills in Excel/Word.

Multitasking

Behavioral

Essential

Desired

Analytical Excel Skills

Communication skills

Supervising/Leadership skills

Teamwork Skills

Influencing skills

Relationship Building skills

Decision making skills

F Incumbent Characteristics

Essential

Qualification

Doctor

Experience

10-12 years of experience in Health (Including UW Claim)