Knowledge of Claims processes: Indemnity (Cashless, Reimbursement), Fixed Benefit Products
Understanding of Claims systems (process flow & System fields) – Health, PA & Travel
Experience in measurement of performance (TAT, accuracy in claims adjudication)
Expectations management of the Claims team
TAT & expectations management for specialized business handling.
Ensure uniformity in quality & maintain TATs of Claims decisions
Create & maintain standards/protocols for Claims team
Audit claims decisions in adherence & compliance with the Claims guidelines, uniformity in decisions, and approval authority limits (In house and TPA claims)
