Senior Manager Health Claims

TATA AIG General Insurance Company Limited · Uttar pradesh, India

• Lead and manage a team of Non-Medical Claims Adjudicators handling Cashless and Reimbursement health insurance claims.
• Ensure timely and accurate adjudication of claims in accordance with policy terms, company guidelines, and regulatory requirements.
• Monitor daily claim inventories, workload distribution, and claim pendency to ensure efficient operations.
• Supervise and review the performance of team members, providing regular coaching, feedback, and support.
• Conduct supervisor audits of processed claims to ensure adherence to quality standards and operational procedures.
• Oversee the activities of the DEO and Inward teams, ensuring accuracy and timely completion of assigned tasks.
• Review and analyze daily operational reports related to claim processing, productivity, quality, and turnaround times.
• Handle escalated cases and coordinate with internal stakeholders for effective resolution of issues.
• Ensure error-free data capture and maintain high standards of quality across the claims processing lifecycle.
• Drive process improvement initiatives to enhance operational efficiency and customer experience.
• Promote the use of digital tools and technologies, including OCR-based processing, to improve automation and productivity.
• Identify training needs and facilitate skill development programs for team members.
• Support compliance, audit, and risk management requirements by ensuring adherence to established processes and controls.
• Prepare management reports and provide insights on team performance, operational trends, and improvement opportunities.
• Foster a collaborative, high-performance work environment focused on service excellence and continuous improvement.