Claims Reimbursement Manager

MediBuddy; Bengaluru; On-site; INR 600,000 - 900,000; 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 and governance. The role requires a 1-2 year background, preferably from premier engineering institutes, with strong analytical skills, process ownership, and experience in Excel-based data analysis.

You will drive SOPs, track SLAs, and coordinate with insurers to ensure accurate, timely reimbursements.

Qualifications

• Engineering degree from IIT/NIT/BITS.
• 1–2 years of professional experience in operations or analytics.
• Health insurance/TPA experience is a plus.

Responsibilities

• Manage end-to-end Reimbursement Claims department, daily claim volumes and team output.
• Own and monitor claim adjudication turnaround times (TAT) and SLAs across corporate accounts.
• Coordinate with insurer partners; drive resolution of adjudication queries and escalations.
• Design, document, and implement SOPs for claim intake, adjudication, escalation and debit note issuance.
• Own critical escalations; perform root-cause analysis and permanent resolution.
• Lead, mentor and performance-manage a team of claims specialists and team leads; set OKRs.
• Ensure accurate daily/weekly/monthly claim reconciliation; present MIS dashboards to leadership.
• Partner with Product, Tech, and Vendor Management to drive automation in the claims workflow.

Skills

Analytical thinking

Problem-solving

Team leadership

Ownership mindset

Process design

SOP documentation

Education

B.Tech / B.E. or equivalent (IIT/NIT/BITS)

Tools

Excel

Job description

We are looking for a driven Claims Manager to lead the Reimbursement Claims department, overseeing end-to-end claim 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 claim volumes, team productivity, and overall operational output.
• TAT Adherence: Own and monitor claim adjudication turnaround times (TAT); design and enforce controls to ensure claims are processed within defined SLAs across all corporate accounts.
• Insurer Coordination: Serve as the primary point of contact for insurer partners; drive resolution of adjudication 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 and permanent resolution to prevent recurrence.
• Team Leadership: Lead, mentor, and performance-manage a team of claims specialists and team leads; set OKRs and track individual and team performance.
• Reconciliation & Reporting: Ensure accurate daily, weekly, and monthly claim reconciliation; present operational MIS and dashboards to leadership.
• Cross-functional Coordination: Partner with Product, Tech, and Vendor Management teams to drive automation and system improvements in the claims workflow.

Qualifications & Experience

Skills Required

• B.Tech / B.E. or equivalent degree from IIT, NIT, or BITS
• 1-2 years of professional experience (any industry) Prior exposure to operations, analytics, or process driven roles preferred
• Health insurance / TPA / claims background is a plus, not mandatory
• 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