Walk-in | Manager - Global Business (Medical Underwriting)

Care Health Insurance; Gurugram District; In loco; INR 500.000 - 800.000; Tempo pieno

Descrizione del lavoro

Care Health Insurance is seeking an underwriting professional to assess individual medical cases daily, applying strong medical knowledge and awareness of health insurance exclusions. The role involves coordinating with brokers, evaluating group underwriting based on utilization and loss ratios, and auditing claims for fraud or misuse.

PED and medical reports guide decisions on new policy additions. Candidates should possess medical degrees such as BHMS/Physiotherapy/BAMS and demonstrate

Competenze

• Advanced Excel skills for data analysis and reporting.
• Strong medical knowledge to analyse health cases.
• Familiarity with health insurance exclusions and TOB.

Mansioni

• Underwrite individual cases daily within set time frames.
• Coordinate with brokers on underwriting cases.
• Perform group underwriting based on claim utilization and loss ratio evaluations.
• Evaluate new policy additions using PED and medical reports.
• Audit claims data to identify fraud, overutilization, medical justification, and declarations.

Conoscenze

Advanced Excel

Formazione

BHMS

Physiotherapy

BAMS

Descrizione del lavoro

Role & responsibilities

• Underwriting Individual cases on daily basis within the set time frame.
• Should have the proper medical knowledge to analyses the case.
• Co-ordinations with various brokers related to underwriting cases.
• Group underwriting based on the claim utilization or overall data with the loss ratio evaluation and anticipating future inpatients. New additions in the policy to be evaluated based on the PED and medical reports.
• Should be well versed with the exclusion of Health Insurance product and its TOB.
• Solving the claims related queries within the time frame.
• Audit the claims on the given data to find out the fraud /overutilization/ medical justification /Declarations.

Measures of Success for the Role

• Timely Response to cases on TAT basis
• Accuracy
• No escalation from broker
• Building relationships with broker

Preferred candidate profile:

• BHMS/ PHYSIOTHERAPY/BAMS
• Advance excel
• Excellent in medical cases analytical, logics and problem solving skills.
• Ability to work both independently and as part of a team