Senior Manager – Health Management Team

ICICI Lombard Group; Mumbai; On-site; INR 1,500,000 - 2,100,000; Full time

Job summary

ICICI Lombard Group in Mumbai is seeking a Senior Manager – Health Management Team to lead claims assessment, medical review, and tariff adjudication, ensuring policy terms are followed and cashless approvals are properly processed.

The role requires 1-2 years in health insurance claims or related areas, strong analytical and communication skills, and the ability to coordinate with network hospitals and internal teams in a fast-paced, rotational shift environment.

Qualifications

• MBBS/BAMS/BHMS or equivalent medical qualification.
• Strong understanding of health insurance policies and medical terminology.
• Analytical and detail-oriented.
• Excellent communication and decision-making skills.
• Ability to work in rotational shifts.
• 1–2 years in Health Insurance Claims/Underwriting/Investigation.

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

Analytical mindset

Communication skills

Decision making

Team collaboration

Adaptability

Education

MBBS/BAMS/BHMS or equivalent medical qualification

Job description

We have exciting opportunities for the role of Senior Manager – Health Management Team

Notice Period

Education (Full Time / part Time

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: 1-2 years in Health Insurance Claims/Underwriting/Investigation etc.