Claims Reimbersement Manager

Medibuddy; Bengaluru; On-site; INR 900,000 - 1,300,000; Full time

Job summary

Medibuddy in Bengaluru is seeking a driven Claims Manager to lead the Reimbursement Claims department, overseeing end-to-end claim operations, adherence to TATs, insurer coordination, and governance.

The role suits a high-potential graduate with 1-2 years of relevant health insurance operations experience who can design SOPs, drive process improvements, and mentor a team of claims professionals.

Qualifications

• B.Tech / B.E. or equivalent degree, preferably from a premium institute.
• 1-3 years of professional experience, any industry.
• Proven experience in managing or mentoring a team.
• Prior exposure to operations, analytics, or process-driven roles preferred.
• Health insurance / TPA / claims background is a plus, not mandatory.

Responsibilities

• Department Management: Oversee end-to-end Reimbursement Claims department and daily claim volumes.
• TAT Adherence: Monitor adjudication turnaround times and enforce SLAs across corporate accounts.
• Insurer Coordination: Act as primary contact for insurer partners and drive resolution of queries.
• SOP Setup & Process Governance: Design, document, and implement SOPs for claim intake, adjudication, escalation, and debit notes.
• Escalation Management: Own critical escalations and drive root-cause analysis and permanent fixes.
• Team Leadership: Lead, mentor, and performance-manage a team of claims specialists and leads.
• Reconciliation & Reporting: Ensure daily/weekly/monthly reconciliation and present MIS to leadership.
• Cross-functional Coordination: Partner with Product, Tech, and Vendor Management to drive workflow improvements.

Skills

Strong analytical and problem-solving

Process design and SOP documentation

Advanced Excel / data analysis

Stakeholder and insurer coordination

Team leadership and performance

Ownership mindset with execution bias

Education

B.Tech / B.E. or equivalent degree

Job description

Role Summary:

We are looking for a driven Claims Manager to lead the Reimbursement Claims department, overseeing end-to-endclaim operations, TAT adherence, insurer coordination, and process governance. This role is ideal for a high potential graduate from a premier engineering institute (IIT / NIT / BITS) with 1-2 years of experience, looking to build a career in health insurance operations and claims management. The ideal candidate combines strong analytical rigor with hands-on process ownership, building and enforcing SOPs that scale claim operations across corporate accounts.

Key Responsibilities:

• Department Management: Manage the end-to-end Reimbursement Claims department, overseeing daily claimvolumes, team productivity, and overall operational output.
• TAT Adherence: Own and monitor claim adjudication turnaround times (TAT); design and enforce controls toensure claims are processed within defined SLAs across all corporate accounts.
• Insurer Coordination: Serve as the primary point of contact for insurer partners; drive resolution ofadjudication queries, escalations, and reconciliation discrepancies.
• SOP Setup & Process Governance: Design, document, and implement SOPs for claim intake, adjudication,escalation handling, and debit note issuance; drive continuous process improvement.
• Escalation Management: Own critical AM and insurer escalations; ensure timely root-cause analysis andpermanent resolution to prevent recurrence.
• Team Leadership: Lead, mentor, and performance-manage a team of claims specialists and team leads; setOKRs and track individual and team performance.
• Reconciliation & Reporting: Ensure accurate daily, weekly, and monthly claim reconciliation; presentoperational MIS and dashboards to leadership.
• Cross-functional Coordination: Partner with Product, Tech, and Vendor Management teams to driveautomation and system improvements in the claims workflow.

Qualifications:

• B.Tech / B.E. or equivalent degree preferrably from a premium institute
• 1-3 years of professional experience (any industry)
• Proven experience in managing or mentoring team
• Prior exposure to operations, analytics, or processdriven roles preferred
• Health insurance / TPA / claims background is a plus,not mandatory

Skills Required:

• Strong analytical and problem-solving skills
• Process design and SOP documentation
• Advanced Excel / data analysis
• Stakeholder and insurer coordination
• Team leadership and performance management
• Ownership mindset with bias for execution