Manager - Underwriting

A Position Overview

Position Title

• Manager- Underwriting

Department

• Operations Underwriting

Level / Band

• 401

Role Summary

• Responsible for Health claim processing (including End to End processing of claims) & TAT management
• Expertise in reviewing claim documents, medical opinions and understanding policy terms and conditions
• Risk assessment and triggering verification of suspicious claims
• Should be able to coordinate with FIU team, sales team, product team, legal team, complaints team, vendors etc for claims processing, escalations & litigation cases etc.
• Team management

B Organizational Relationships

Reports To

• Senior Manager

Supervises

• AM

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 & ability to take claim decisions as per policy terms and conditions
• Ensure 100% quality completion of Claim decision
• Ensure all cases are received 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 new team members
• Ensure quality & accuracy of Claims process
• Sharing feedback and conducting meetings with the relevant stakeholders 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
• 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

• 8-12 years of experience in Health claim processing