Corporate Manager - Medical Claims - MBBS

Responsibilities :

• Team Management : Lead and manage a team responsible for the processing of medical claims, ensuring high standards of efficiency and accuracy.
• Claim Evaluation & Decision Making : Oversee and make critical decisions regarding the genuineness and validity of customer claims. This includes evaluating claims against policy terms and medical documentation to ascertain the appropriateness of the treatment.
• Policy & Medical Compliance : Ensure that all claim decisions are strictly in line with established company policy guidelines and align with medical best practices and documentation.
• Quality Assurance : Implement and monitor quality control measures for claim processing, identifying areas for improvement and ensuring consistent accuracy.
• Discrepancy Resolution : Guide the team in resolving discrepancies in claims, working closely with relevant stakeholders to ensure fair and accurate outcomes.
• Process Improvement : Continuously identify opportunities to enhance the claims processing workflow, implementing efficiencies without compromising quality or compliance.
• Training & Mentorship : Provide ongoing training and mentorship to the claims processing team, enhancing their medical and policy evaluation skills.

Required Skills :

Skills Required

Team Management, Decision Making, Quality Assurance, Mbbs, Analytical Skills