Job Description JOB SUMMARY
ø Manage Health Claims vertical & related processes.
ø Develop efficient and sustainable Health Claims support model for Tata AIA policyholders.
ø Identify customer preferences and work towards meeting / exceeding customer satisfaction.
End to End Management of Health Claims including management of Third-Party Administrator
o Control and monitor Health claims processes and ensure compliance with Tata AIA and Regulatory norms.
o Ensure understanding of the Health Claims processes by Distribution force by way of training, interaction, monitoring and feedback.
o Ensure automation of Health claims processing.
o Monitor Health claims processes as per below details-
Manage Claims evaluation standards and TATs
Manage and effectively liaise with Health Third Party Administrator
Adjudicate health claims and facilitate assessment through inhouse team or through Health Third Party Administrator
Measure of Success :
ø Accuracy, Quality, Productivity and Timeliness of claims support processing and Query handling.
ø Claims Audit Ratings.
ø Adherence to process, Regulatory & Compliance benchmarks.
ø Customer complaints & Query handling
Accuracy of claims approvals done as per authority limit.
IMPORTANCE OF THE POSITION
Claims is a key business area for Tata AIA Operations.
The selected candidate will require maintaining extremely good understanding of Health Business end to end with specific focus on claims assessment and data management.
He / She will have to develop and sustain an effective Health Claims Subunit at Tata AIA Life.
Success in this role will require high initiative and the ability to quickly learn and cross-pollinate successful ideas.
The ultimate goal is to help Tata AIA Claims Team achieve key business metrics and end customer satisfaction while ensuring that all other Stakeholders' expectations are effectively met.