Roles &amp; Responsibilities: • 
1) Exceptional Employee Experience Support system by Prudent

<ul>
<li style="margin-left:0px;">Serve as primary point of contact for all employee claim queries and own the process of developing strong employee relationships &amp; engagement</li>
</ul>

2) Facilitating the cashless and reimbursement process:

<ul>
<li style="margin-left:0px;">Ensuring employees understand the steps involved in both cashless and reimbursement claims.</li>
</ul>

<ul>
<li style="margin-left:0px;">Offering exceptional support and guidance to employees/HR throughout the entire process to ensure a smooth experience.</li>
</ul>

3) E-cards/network hospitals:

<ul>
<li style="margin-left:0px;">To provide employees e-cards and information about network hospitals.</li>
</ul>

4) Providing claim-related queries:

<ul>
<li style="margin-left:0px;">Addressing questions about claim status, claim deductions, and explanations of queries.</li>
</ul>

5) TPA Co-ordination:

<ul>
<li style="margin-left:0px;">Co-ordinating with TPA daily to ensure the smooth functioning of employee-related queries</li>
</ul>

6) Employee Engagement &amp; Support SPOC:

<ul>
<li style="margin-left:0px;">Daily tracking of claims on status/rejections/deductions and providing the report to MCS </li>
</ul>
Desired profile/who should join: 
<ul>
<li style="margin-left:0px;">Good listening &amp; communication skills</li>
</ul>

<ul>
<li style="margin-left:0px;">Should have good technical knowledge about Employee health Insurance/ General Insurance products. (Cashless/Reimbursements)</li>
</ul>

<ul>
<li style="margin-left:0px;">Experience in General Insurance/ Insurance Brokers</li>
</ul>

<ul>
<li style="margin-left:0px;">Years of experience: 2 to 5 years</li>
</ul>

<ul>
<li style="margin-left:0px;">Education qualification: Bachelor's Degree, Master's Degree</li>
</ul>

<ul>
<li style="margin-left:0px;">Good knowledge of the TPA/Insurance processes</li>
</ul>

<ul>
<li style="margin-left:0px;">Well-versed in health insurance policy conditions</li>
</ul>

<ul>
<li style="margin-left:0px;">Well-versed with current medical practices &amp; advancements</li>
</ul>

<ul>
<li style="margin-left:0px;">Should know about IRDAI health regulation</li>
</ul>

Claims Manager in Mumbai (UID-10263)

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Job Description for Claims Manager

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