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Manager - Underwriting

Manager - Underwriting

ConfidentialThane
20 days ago
Job description

A 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

    • Skills Required

    Leadership, medical background , Decision Making, Analytical Skills, Excel

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