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Manager - Underwriting
Job Description & How to Apply Below
Position Overview
Position Title
Manager
- Underwriting
Department
Operations Underwriting
Level / Band
401
Role Summary
Responsible for Health claim processing (including End to End processing of claims) & TAT management
Expertise in reviewing claim documents, medical opinions and understanding policy terms and conditions
Risk assessment and triggering verification of suspicious claims
Should be able to coordinate with FIU team, sales team, product team, legal team, complaints team, vendors etc for claims processing, escalations & litigation cases etc.
Team management
B Organizational Relationships
Reports To
Senior Manager
Supervises
AM
C Job Dimensions
Geographic Area Covered
Pan India
Stakeholders Internal
FIU team, sales team, product team, legal team, complaints team
External
Customer/ Policyholder, Vendor
- Prorisk/ Medi Assist
D Key Result Areas
Organization Process
Key Contribution
To ensure quality & accuracy of Health Claim processes
Good knowledge on insurance & products & ability to take claim decisions as per policy terms and conditions
Ensure 100% quality completion of Claim decision
Ensure all cases are received by the department as per the specified inter & intra department SLAs.
Presenting case summary and representing to reinsurers, communicating with distribution stakeholders
Ensure adherence to defined claims TAT & decision accuracy
Mentor, guide & train new team members
Ensure quality & accuracy of Claims process
Sharing feedback and conducting meetings with the relevant stakeholders time to time
Evaluate emerging trends, competition practices and propose recommendations to senior management
Should be able to work on weekends and second shift
Managing the entire team and responsible for End to end TATs of Health claims as per regulatory guidelines
E Skills Required
Technical
Medical background
- Education - minimum BAMS / BHMS / BDS
Experience - insurance experience, life + Health UW/claims
Effective presentation and interpersonal skills
Good system skills in Excel/Word
Multitasking
Behavioral
Essential
Analytical & Excel Skills
Communication skills
Supervising/Leadership skills
Teamwork Skills
Influencing skills
Relationship Building skills
Decision making skills
F Incumbent Characteristics
Essential
Qualification
Doctor
Experience
8-12 years of experience in Health claim processing
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