Senior Manager Health Claims

TATA AIG General Insurance Company Limited; Dadri; On-site; INR 1,200,000 - 2,000,000; Full time

Job summary

TATA AIG General Insurance Company Limited is seeking a Lead to manage a team of Non-Medical Claims Adjudicators handling cashless and reimbursement health insurance claims in India.

The role focuses on timely and accurate adjudication, supervising staff, coaching, and regular audits to ensure quality and adherence to procedures. Location: Dadri, Uttar Pradesh.

Responsibilities

• Lead and manage a team of Non-Medical Claims Adjudicators handling Cashless and Reimbursement health insurance claims.
• Ensure timely and accurate adjudication of claims in accordance with policy terms, guidelines, and regulatory requirements.
• Monitor daily claim inventories, workload distribution, and claim pendency to ensure efficient operations.
• Supervise and review the performance of team members, providing regular coaching, feedback, and support.
• Conduct supervisor audits of processed claims to ensure adherence to quality standards and procedures.
• Oversee the activities of the DEO and Inward teams, ensuring accuracy and timely completion of assigned tasks.
• Review and analyze daily operational reports related to claim processing, productivity, quality, and turnaround times.
• Handle escalated cases and coordinate with internal stakeholders for effective resolution of issues.
• Ensure error-free data capture and maintain high standards of quality across the claims processing lifecycle.
• Drive process improvement initiatives to enhance operational efficiency and customer experience.
• Promote the use of digital tools and technologies, including OCR-based processing, to improve automation and productivity.
• Identify training needs and facilitate skill development programs for team members.
• Support compliance, audit, and risk management requirements by ensuring adherence to established processes and controls.
• Prepare management reports and provide insights on team performance, operational trends, and improvement opportunities.
• Foster a collaborative, high-performance work environment focused on service excellence and continuous improvement.

Job description

• Lead and manage a team of Non-Medical Claims Adjudicators handling Cashless and Reimbursement health insurance claims.
• Ensure timely and accurate adjudication of claims in accordance with policy terms, company guidelines, and regulatory requirements.
• Monitor daily claim inventories, workload distribution, and claim pendency to ensure efficient operations.
• Supervise and review the performance of team members, providing regular coaching, feedback, and support.
• Conduct supervisor audits of processed claims to ensure adherence to quality standards and operational procedures.
• Oversee the activities of the DEO and Inward teams, ensuring accuracy and timely completion of assigned tasks.
• Review and analyze daily operational reports related to claim processing, productivity, quality, and turnaround times.
• Handle escalated cases and coordinate with internal stakeholders for effective resolution of issues.
• Ensure error-free data capture and maintain high standards of quality across the claims processing lifecycle.
• Drive process improvement initiatives to enhance operational efficiency and customer experience.
• Promote the use of digital tools and technologies, including OCR-based processing, to improve automation and productivity.
• Identify training needs and facilitate skill development programs for team members.
• Support compliance, audit, and risk management requirements by ensuring adherence to established processes and controls.
• Prepare management reports and provide insights on team performance, operational trends, and improvement opportunities.
• Foster a collaborative, high-performance work environment focused on service excellence and continuous improvement.