Claims Manager

Family Health Plan (FHPL); Hyderabad; On-site; INR 450,000 - 650,000; Full time

Job summary

Family Health Plan (FHPL) Hyderabad seeks a capable candidate with BAMS/BHMS/BUMS/BDS qualifications and registration to oversee claims adjudication. The role includes managing medical officers, resolving customer queries, and coordinating with the insurance health department to ensure smooth operations.

You will lead a team, communicate effectively with customers and internal teams, respond to insurer audits, and identify training needs.

Qualifications

• Excellent communication and managerial skills.
• Experience in claims adjudication is a must.
• Experience handling a team of medical officers.

Responsibilities

• Coordinate with the insurance health department for daily operations.
• Monitor daily outstanding of claims.
• Clarify CRM and billing queries.
• Provide coverage details to customers via information emails.
• Support CS team with medical clarifications.
• Assist customers and resolve concerns effectively.
• Work with senior management for smooth operations.
• Respond to audit queries from insurers.
• Clarify medical policy details to customers and corporates.
• Identify and plan training needs for recruits and existing staff.
• Monitor and guide medical audits.
• Guide Medical Officers in scrutiny work as needed.
• Interact with department heads as required.

Skills

Communication skills

Managerial skills

Team handling

Education

BAMS/BHMS/BUMS/BDS with registration

Job description

Role & responsibilities

• Regular meeting and coordinating with the insurance health department.
• Monitoring daily outstanding of claims.
• Clarifying queries of CRM and billing teams.
• Providing coverage details to the customers through info mails.
• Providing clarifications to CS team wherever required.
• Responsible for assisting customers and effectively resolving their concerns.
• Works closely with the senior management to ensure smooth operations.
• Replying to the audit queries raised by the insurers.
• Clarifying queries related to medical aspects to the customers and corporate.
• Identify & plan training needs for recruits & existing employees.
• Monitoring and guiding on the medical audit.
• Guiding Medical Officers in scrutiny work whenever and wherever needed related to policy conditions and medical aspects.
• Interaction with all the department HOD's as & when required.

Preferred candidate profile

BAMS/BHMS/BUMS/BDS graduates with registration and relevant experience in Claims Adjudication is must.

Experience in handling team of medical officers.

Excellent communication and managerial skills.