Corporate Manager - Medical Claims - MBBS

Responsibilities:

• Team Management: Lead and manage a team responsible for the processing of medical claims, ensuring high standards of efficiency and accuracy.
• Claim Evaluation & Decision Making: Oversee and make critical decisions regarding the genuineness and validity of customer claims. This includes evaluating claims against policy terms and medical documentation to ascertain the appropriateness of the treatment.
• Policy & Medical Compliance: Ensure that all claim decisions are strictly in line with established company policy guidelines and align with medical best practices and documentation.
• Quality Assurance: Implement and monitor quality control measures for claim processing, identifying areas for improvement and ensuring consistent accuracy.
• Discrepancy Resolution: Guide the team in resolving discrepancies in claims, working closely with relevant stakeholders to ensure fair and accurate outcomes.
• Process Improvement: Continuously identify opportunities to enhance the claims processing workflow, implementing efficiencies without compromising quality or compliance.
• Training & Mentorship: Provide ongoing training and mentorship to the claims processing team, enhancing their medical and policy evaluation skills.

Required Skills:

• MBBS qualification from an Indian institution.
• Strong medical acumen to evaluate treatment appropriateness and medical documents.
• Ability to manage and lead a team responsible for processing claims.
• Proficiency in making decisions based on policy guidelines and medical assessments.
• Excellent analytical and problem-solving skills for claim evaluation.
• Strong communication and interpersonal skills to interact with team members and stakeholders.
• High level of attention to detail and commitment to accuracy.