Team Member - RI Claims

Aditya Birla Group; Thane; Sur place; INR 600 000 - 1 000 000; Plein temps

Résumé du poste

Birla Carbon is looking for an Assistant/Deputy Manager – Claims in Thane, Maharashtra. The role involves ensuring the timely settlement of Travel and OPD claims while performing audits and maintaining reports. Candidates should possess excellent Excel skills, coordination abilities, and a strong background in claims processes. You'll work closely with both internal MIS teams and external service providers, focusing on accurate data submission and compliance monitoring.

Qualifications

• Experience in managing claims processes, preferably in a service operation environment.
• Strong coordination skills and ability to work with multiple stakeholders.
• Familiarity with MIS reporting and data management.

Responsabilités

• Ensure timely submission of claims reports.
• Train partner claim processors on policy procedures.
• Monitor compliance checks and audit observations.

Connaissances

Excel proficiency

Soft skills

Technical auditing

Description du poste

At the Aditya Birla Group, our Corporate Vision is aligned and intricately woven with our People Vision.

Team Member - RI Claims

Job Description

Designation: Assistant/Deputy Manager – Claims

Reports to: Manager/Sr. Manager – Services Operations

Job Purpose

The purpose of this role includes ensuring coordination with the Service provider partner team for timely settlement of Travel and OPD claims. The candidate should be able to perform regular medical and technical audits of the claims approved for settlement by the partner and maintain the MIS/Reports related to claims.

Key Responsibilities (Key Result Areas)

• Accurate and timely submission of periodic and ad-hoc reports related to Claims
  • Develop, implement shortcuts and formulas in Excel, using alternative tools/methods for timely submission
  • Perform cursory/sanity checks before submission
• Closure of audit observations
  • Train partner claim processors regarding policy T&C, time management, delegation
  • Coordinate with other departments, exercise soft skills and Excel proficiency
• Monthly / Quarterly / Annual Data submission
  • Work closely with related stakeholders (internal and external)
• Working on DATA / MIS
  • Collaborate with external data teams for reports such as LDR report & monitoring, daily intimation reports, monthly MIS checks for TAT
• Debit Note (DN) monitoring for checkpoints
  • Ensure compliance checks (DOA, dates, policy periods, etc.)
• MVP implementations with OPD partners
  • Coordinate with partner leadership and tech teams for automated triggers, ICD‑10 coded data, home collection utilization, FWA investigations, reimbursement claim adjudication engine alignment, real‑time dashboards, ABHI access, communication letters, reports, query management, medicos process, data digitization, API integrations, limits & sublimits, portal validation, cashless portal, claim outstanding report, symptom linking

Relationships

Internal (MIS Team) – Ongoing coordination for data requirement and processing payments of the partner.

External (Service Providers) – As required, for decisions on claims, reconsideration claims, and enhancements.