Manager Claims-(PHR/1001/5)

JOB DESCRIPTION

Purpose of the Role

The Manager – Claims is responsible for evaluating medical claims in accordance with policy terms and conditions, ensuring accurate and timely processing of reimbursement, OPD, and hospital claims while maintaining effective coordination with internal teams, hospitals, and clients.

Key Responsibilities

• Supervise all reimbursement, OPD, and hospital claims processes.
• Ensure timely and accurate medical evaluation of reimbursement claims and related cases.
• Conduct timely medical evaluation of hospital and OPD claims in line with policy guidelines.
• Handle medical claims–related queries from internal and external stakeholders.
• Communicate with clients via email or formal correspondence regarding medical claims matters.
• Build and maintain strong professional relationships with hospitals and clients.
• Coordinate closely with Senior Management and Medical Evaluation teams to ensure smooth claims operations.
• Perform any additional tasks assigned by management within agreed timelines.

Requirements

• Education: MBBS
• Experience: 7–9 years of relevant experience
• Industry: Insurance (Health Claims preferred)
• Skills & Competencies:
• Medical claims evaluation
• Strong coordination and stakeholder management skills
• Effective written and verbal communication

Job Type: Full-time

Pay: Rs150,000.00 - Rs200,000.00 per month

Work Location: In person