India Job Openings
Link K Insurance TPA Pvt Ltd
Senior manager ,claims
FULL TIME
September 2, 2024
Head- Operations
Position based out of Chennai
Qualification
Experience:
Position based out of Chennai
Qualification
- Graduate in any discipline
- A doctor with health insurance experience preferable
- Minimum 15 years of experience in health insurance space in India
- Thorough knowledge about health insurance products/ policies of various insurers
- Ability to read/ understand/interpret various health policy terms and conditions
- Knowledge about TPA business that includes hospital network management
- Knowledge about regulatory requirement /IRDAI compliance w r t customer service and claims processing
- Understanding of how online enrolment function and claims software
- Leading team leaders from multiple functions like hospital network management, cashless and claims and enrolment
- Defining process flows and SOPs of all core functions, enrolment and claims Ensuring smooth onboarding of new insurers
- SPOC to all insurers for any escalations Ensuring policy and member enrolment error free as per SLAS of each insurer
- Ensuring e-card / physical card delivery as applicable as per stake holder requirement Interacting with internal and external stake holders for smooth policies , endorsements and data flow.
- Ensuring training of all employees under various functions, includes both system training and functional training
- Ensuring smooth cashless and claims processing right from receipt of request to payment file
- Monitoring TATS , ensuring to meet SLAS meticulously Driving backend CRM and contact centre operations
- Close integration with customer service/corporate relations departments to understand the customer expectation and delivery
- Giving inputs to IT for new requirements as per insurers requirements , enhancement of features and working towards auto adjudication of claims
- Tracking IT requirements for development and coordination with IT vendors and IT dept for closure
- Ensuring testing of IT delivery in UAT and signing off to take to production
- Monitoring inward of documents through all channels at all locations , giving appropriate direction for quicker turnaround time for registration of claims and processing
- Managing the contact centre and backend CRM functions effectively Demonstrate constant efforts towards process improvements.
- Ensuring smooth claims payment flow and interaction with insurers wherever required
- Overall delivery of enrolment, claims and contact centre management
Experience:
- total work: 1 year (Preferred)
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