Head - Accident & Health Claims

TaglynkRepublic Of India, IN

6 days ago

Job description

TagLynk Careers, hiring partner for a leading insurance organization, is looking for a senior leader to drive Accident & Health Claims Strategy & Operations . This role is ideal for seasoned professionals with deep expertise in health insurance claims, fraud mitigation, provider network management and regulatory compliance.

🔹 Key Responsibilities

Strategic Leadership

Build and drive end-to-end Accident & Health Claims strategy , frameworks and processes.
Ensure compliance with latest health insurance regulations;

implement process refinements.

Lead the move towards paperless, automated claims settlement with superior TAT & customer experience.

Design and monitor performance metrics for TPAs and internal claims teams.

Collaborate with technology teams to build / enhance claims systems & automation .

Build strong partnerships with external stakeholders : TPAs, investigators, hospitals, OSPs, providers .

Drive continuous improvement, best practices, and customer-first delivery.

Financial & Risk Management

Partner with audit & fraud teams to implement fraud prevention and loss-mitigation frameworks .

Manage claims budgets, average claims cost and cost-containment initiatives.

Analyze ICR , medical data and portfolio trends;

drive proactive risk control.

Support product, U / W and actuarial teams with insights for guideline finalization.

Lead periodic reporting for internal & regulatory stakeholders.

Functional & Operational Excellence

Lead teams managing claims processing, customer queries, complaints, reserving & registration.

Oversee adjudication of complex claims : indemnity, critical illness, accidental death .

Manage network providers, evaluate & empanel TPAs / OSPs, drive performance management.

Partner closely with product / business teams to strengthen service capability.

People Leadership

Drive a culture of accountability, high performance and continuous learning.

Set goals, mentor teams, review performance, and build future leaders in claims operations.

Strengthen collaboration across cross-functional internal teams.

Desired Profile

MBBS / BAMS / BHMS / B.Pharm preferred;

or any graduate with health insurance certifications.

15–20 years of experience in health insurance / TPA / wellness / healthcare domains.

Strong exposure to claims operations, adjudication, medical review, fraud control, underwriting basics, hospital administration, and provider network management .

Proven leadership in handling large teams and multi-stakeholder environments.

Excellent analytical, communication, negotiation and people management skills.

🔹 Key Stakeholders

Internal : Product, U / W, Distribution, Customer Service, Technology, Compliance, Finance

External : TPAs, Hospitals, Investigators, Providers, Corporates, Customers

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Head • Republic Of India, IN

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