Job openings for claims manager in mumbai thane

Job profile:
• To ensure to publish MIS, Regulatory Data submission, Analysis on periodic basis with effective controls built in and allied activities by overcoming system and infrastructure constraints.
• To identify trends, alert and suggest strategies towards risk/fraud mitigation strategies and policies within the framework of Compliance/ Group’s Policies.
• To identify and prevent regulatory breach of Claims TAT’s, and timely data submission by overcoming challenges related to systems and infrastructure, using manual methods where required.
• Accurate and timely submission of periodic and ad-hoc reports related to Claims to the Regulatory Authority/GI Council
• Audits: IRDA, Internal, Stat, others
• Data submission/query response/ad-hoc reports to IRDA/GI Council
• Closure of audit observations
• Monthly / Quarterly / Annual Data submission
• Policyholder’s protection committee, Quarterly board meetings, monthly Ops Review, Weekly Claims Review
• Develop, Implement shortcuts, macros, formulae on excel, using alternative tools/methods for timely submission
• Develop, train the team, delegate and review their accountability
• Do cursory/sanity check before submission
• Team training, Time management, Delegation
Strong coordination skills with other departments, sharp and on the spot thinking, proactive approach, soft skills, excel skills, working with other tools/macros
• Work closely with Finance, Actuary, Operations, Internal Claims team.
• To decide on complex claims, reconsideration claims and claims beyond the authority of the Claims Department
• To decide on complex claims, ex-gratia claims, reconsideration claims and claims beyond the authority of the Claims Committee
• Business forecast, MIS, query resolutions etc.
• Claims status, query resolutions, MIS
• System issues, queries, testing and system developments/ enhancements


Technical skills: Reimbursement claims, MIS , Insurance, health insurance, medical insurance

Soft skills: Team leader