AM- Claims ( Thane)

Aditya Birla Health Insurance Company Limited; Maharashtra; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

Aditya Birla Health Insurance Company Limited is seeking a Claims professional to drive process knowledge, system understanding, and performance oversight across Health, PA and Travel claims. The role emphasizes uniform decision quality, standards creation, and audit compliance to ensure timely claims adjudication.

The candidate will lead the claims team, manage expectations for specialized cases, and uphold service levels across in-house and TPA claims, ensuring adherence to guidelines.

Responsibilities

• 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)

Job description

• 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)