Manager - Health Claims

Tata AIA Life Insurance; Thane; On-site; INR 1,400,000 - 2,400,000; Full time

Job summary

Tata AIA Life Insurance is seeking a Manager in Health Claims to oversee end-to-end health claim processing across Pan India. The role focuses on speedy, accurate decisions, regulatory compliance, and collaboration with FIU, sales, product, legal and complaints teams.

You will mentor the team and ensure adherence to SLAs while maintaining data integrity in claims systems. Requires medical background and insurance experience, with strong analytical, communication and leadership skills to drive

Qualifications

• Good knowledge of insurance products and ability to take claim decisions as per policy terms and conditions
• Experience in Health UW/claims processing
• Strong presentation and interpersonal skills

Responsibilities

• Expert in Health claim processing with end-to-end coverage and timely decisions
• Monitor TAT and ensure regulatory TAT breaches are avoided
• Review claim documents, medical opinions and policy terms
• Coordinate with FIU, sales, product, legal and complaints teams for claims and escalations
• Mentor and train team members; manage end-to-end TATs and SLA adherence
• Update claims systems and communicate with customers

Skills

Medical background MBBS/BAMS/BHMS

Insurance experience (life + health UW

Interpersonal skills

Excel

Multitasking

Analytical skills

Communication skills

Teamwork

Relationship building

Decision making

Education

MBBS / BAMS / BHMS

Tools

Excel

Word

Job description

Position Overview

Position Title - Manager

Department - Health Claims

Role Summary:

• Responsible for Health claim processing (including End to End processing of claims) with Speedy decisions of all Health claims with strong eye on risk.
• Monitoring the TAT for the portfolio along with ensuring no regulatory TAT breach
• Expertise in reviewing claim documents, medical opinions and understanding policy terms and conditions
• Compliance to all Regulatory requirements and delivery in lines with the same
• Responsible for quality claim decisions within the agreed product guidelines and SLAs
• Understanding trends and liaison with internal stakeholders for exhaustive assessment of documents & facts of claim.
• Updating information in the claims system
• Responsible for all customer communication related to Health claims.
• Responsible for data management for all reports.
• Responsible for claims related complaints and walk in customers.
• Identify areas of improvement and take projects and delivery as per business objective
• Noting the trends of red flags, suspicious claims and reporting to management
• Providing regular feedback to underwriters on voided claims
• Risk assessment and triggering verification of suspicious claims
• Should be able to coordinate with FIU team, sales team, product team, legal team, complaints team, vendors etc for claims processing, escalations & litigation cases etc.
• Team management tracking team productivity, targets and ensuring regulatory TATs are not breached.

Organizational Relationships

Reports to - AVP

Job Dimensions

Geographic Area Covered - Pan India

Stakeholders -

Internal

FIU team, sales team, product team, legal team, complaints team

External

Customer/ Policyholder, Vendor

Key Result Areas

Organization Process

Key Contribution

To ensure quality & accuracy of Health Claim processes

• Good knowledge on insurance & products & ability to take claim decisions as per policy terms and conditions
• Ensure 100% quality completion of Claim decision
• Ensure all cases are received by the department as per the specified inter & intra department SLAs.
• Presenting case summary and representing to reinsurers, communicating with distribution stakeholders
• Ensure adherence to defined claims TAT & decision accuracy
• Mentor, guide & train new team members
• Ensure quality & accuracy of Claims process
• Sharing feedback and conducting meetings with the relevant stakeholders time to time
• Evaluate emerging trends, competition practices and propose recommendations to senior management
• Managing the entire team and responsible for End to end TATs of Health claims as per regulatory guidelines

Skills Required

Technical

• Medical background- Education minimum MBBS/ BAMS /BHMS
• Experience insurance experience, life + Health UW/claims
• Effective presentation and interpersonal skills.
• Good system skills in Excel/Word.
• Multitasking

Behavioral

Essential -

• Analytical & Excel Skills
• Communication skills
• Teamwork Skills
• Relationship Building skills
• Decision making skills