Manager - Health Claims

Job description

**Role Overview** Claims lead for the corporate claims vertical. To manage the entire corporate Claims team and oversee end-to-end claims operations. This role is critical in ensuring our corporate partners and their employees receive a seamless, claims experience. You will be responsible for driving operational excellence, maintaining Evens quality standards, and leading a high-performing team in a fast-paced, digital-first environment. **Key Responsibilities** As the lead, your core responsibilities will include: - Monitoring Claims: Closely supervising the end-to-end lifecycle of OPD and wellness claims to ensure accuracy and compliance. - TAT Maintenance: Taking full ownership of the team's Turnaround Time (TAT) to ensure claims are processed swiftly, reliably & within the. - Time Adherence: Managing team schedules and workflow to ensure consistent operational coverage and productivity. - Daily Targets: Setting and driving the team to meet daily throughput goals while maintaining high quality benchmarks. - Escalation Handling: Acting as the primary point of contact for complex B2B claim disputes, ensuring professional and timely resolutions. - Conduct regular quality audits, feedback sessions, and team coaching. - Identify operational gaps, fraud indicators, and process improvement opportunities. - Ensure compliance with internal policies, audit requirements, and regulatory guidelines. - Support hiring, onboarding, and training of new team members. **Requirements** - 6+ years of experience in claims processing, health insurance, TPA operations, or healthcare operations. - Prior team handling or leadership experience required. - Strong understanding of medical terminologies, OPD claims, and health insurance processes. - Experience managing high-volume claims operations in a fast-paced environment. - Strong analytical, problem-solving, and stakeholder management skills. - Excellent communication, team management, and operational coordination abilities. - Hands-on experience with CRM or claims management systems. - Preferred qualifications- MBBS, BDS, BHMS, BAMS, Nursing or B Pharm.