Senior Manager Health Management Team

ICICI Lombard; Mumbai; On-site; INR 900,000 - 1,300,000; Full time

Job summary

ICICI Lombard in Mumbai seeks an experienced Health Insurance Claims Specialist to assess and process health insurance claims, review medicaldocumentation, and determine eligibility per policy terms.

You will review tariffs, coordinate with network hospitals and internal teams, and ensure precise, timely decisions in a fast-paced environment that requires rotational shift flexibility.

Qualifications

• MBBS/BAMS/BHMS or equivalent medical qualification is preferred.
• Solid knowledge of health insurance policies and medical terminology.
• Analytical mindset with attention to detail.
• Excellent communication and decision-making skills.
• Ability to work collaboratively in a fast-paced environment.
• Flexible to work in rotational shifts.

Responsibilities

• Claims Assessment: Evaluate and process health insurance claims in accordance with policy terms and conditions.
• Medical Review: Identify and flag potential cases of medical abuse or discrepancies in treatment protocols.
• Admissibility Decision: Determine claim eligibility based on thorough review of medical documentation and policy guidelines.
• Tariff Adjudication: Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates.
• Stakeholder Coordination: Liaise effectively with internal teams, network hospitals, and other external stakeholders to ensure smooth claim processing and resolution.

Skills

Medical terminology

Health insurance policies

Analytical thinking

Communication skills

Team collaboration

Shift flexibility

Education

MBBS/BAMS/BHMS or equivalent

Job description

Key Responsibilities:

• Claims Assessment: Evaluate and process health insurance claims in accordance with policy terms and conditions.
• Medical Review: Identify and flag potential cases of medical abuse or discrepancies in treatment protocols.
• Admissibility Decision: Determine claim eligibility based on thorough review of medical documentation and policy guidelines.
• Tariff Adjudication: Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates.
• Stakeholder Coordination: Liaise effectively with internal teams, network hospitals, and other external stakeholders to ensure smooth claim processing and resolution.

Qualifications & Skills:

• MBBS/BAMS/BHMS or equivalent medical qualification (preferred).
• Strong understanding of health insurance policies and medical terminology.
• Analytical mind-set with attention to detail.
• Excellent communication and decision-making skills.
• Ability to work collaboratively in a fast-paced environment.
• Flexible to work in rotational shifts

Experience Required: 4-5 years in Health Insurance Claims/Underwriting/Investigation etc.

# for 4B, Team management skills with 4-8 Yrs of experience with above skillset.