Team Member - Claims

Job Description

Job Purpose

. 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)