This role is responsible for the smooth operational functioning of the health claims function, involving, all claims viz. health indemnity, health benefit, critical illness, travel, and accident & disability.
- Development and publication of adjudication guidelines to the processors for standardization
- Pay and process claims within designated authority level.
- Recruit, empower, plan and lead the claims operations team of the hubs
- Innovate and drive improvement initiatives in the process
- Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Deliver exceptional customer experience by timely and error free processing of claims
- To monitor and control error rates and consistency in processing.
- To review SOP for claims processing and to develop & execute better processes.
- To monitor and appraise performance of claims team.
- To monitor customer complaints, trend and timely resolution.
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