Assistant Manager - Claims (Thane)

Job Overview

This role involves managing and overseeing claims processes and teams for indemnity and fixed benefit insurance products, including health, personal accident, and travel insurance claims.

Key Responsibilities

• Possess thorough knowledge of claims procedures covering both indemnity (cashless and reimbursement) and fixed benefit products.
• Understand the claims systems, focusing on process flows and system data fields relevant to health, personal accident, and travel insurance.
• Monitor and analyze performance metrics such as turnaround time (TAT) and accuracy in claims adjudication.
• Manage and set expectations for the claims team to ensure timely and quality decision-making.
• Oversee TATs and manage expectations related to specialized business handling within claims operations.
• Maintain consistency in the quality of claim decisions while ensuring adherence to required turnaround times.
• Develop and uphold standards and protocols to guide the claims team’s operations effectively.
• Conduct audits of claim decisions to ensure compliance with claims guidelines, consistent decision-making, and adherence to approval authority limits for both in-house and Third-Party Administrator (TPA) claims.