Senior Manager Claims-(PHR/1001/3)

JOB DESCRIPTION:

Purpose of the Role

The Senior Manager – Claims is responsible for overseeing and monitoring claims evaluation and payments for both network and non-network hospitals, ensuring compliance with SLAs and SOPs, timely settlement for clients and service providers, effective utilization control, and minimization of loss ratio.

Key Responsibilities

• Supervise evaluation of network and non-network claims in line with approved SLAs and SOPs.
• Identify and prevent overpayments or undue payments to service providers.
• Highlight and address areas of concern related to claims settlement between service providers and HID.
• Resolve day-to-day operational issues within the claims department efficiently.
• Assist in monitoring team workflow, productivity, target achievement, and completion of objectives.
• Ensure timely and accurate preparation of monthly, quarterly, and annual claims ratio reports.
• Coordinate closely with internal teams, branches, and external stakeholders to ensure smooth claims operations.
• Perform any other tasks as assigned by management within defined timelines.

Requirements

• Education: MBBS
• Experience: 8–10 years of relevant experience
• Industry: Insurance (Health Claims preferred)
• Skills:
• Health insurance claims management
• Claims evaluation & utilization control
• Strong analytical and reporting skills
• Behavioral Competencies:
• Strong leadership and people management skills
• Problem-solving and decision-making ability
• Effective communication and coordination

Job Type: Full-time

Pay: Rs200,000.00 - Rs225,000.00 per month

Work Location: In person