Associate Vice President - Health Management

Role

Cashless claim lead

Designation

AVP- Health Management Team

Location

Hyderabad

Minimum Qualification

MBBS/BAMS/BHMS

Preferred

MBA in Hospital Management / Insurance / Fellow from Insurance Institute of India, Six Sigma Green/ Black belt

Experience

• Strong knowledge of Health Insurance and products
• Must have a minimum of 10 years experience in health claims management with over 5 years managerial experience.
• The candidate can be from health insurance, general insurance, reinsurance, or life insurance industries.
• Extensive experience in health claims processing and administration.
• Proficient in health claim fraud prevention & loss mitigation framework.
• Should have experience in managing large teams.

Roles and responsibility

Understanding of Health Claims and claim related processes.

• Lead a team handling claims, customer queries & complaints, risk & Loss mitigation team , Implement & monitor framework designed.
• Drive health claims policy formulation and optimizing the processes for the function.
• Supervision and medical review of high loss health indemnity claims
• Formulate & ensure faster claims settlement with superior TAT & customer experience.
• Analyze incurred claims ratio, review of portfolio, and take proactive action for loss control measures.
• Stay up to date on amendments and provisions in health insurance regulations & implement changes in claims processes to ensure compliance.
• Conduct Medical data analytics, reporting for the stakeholders like (department head, management committee, regulator, IIB etc.) on defined intervals.
• Train & develop medical processors. Identify key learnings, gaps, and opportunities for individuals to develop the team.
• Build & maintain a relationship with external service partners including but not limited to Sales channel partners, Hospitals etc