Manager TPA Insurance
- Fortis
- 2 - 6 years
- Multi-City, India
- 1 month ago
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- Prayagraj, Varanasi, Ghaziabad, Kanpur, Lucknow, Agra
Job Description
Fortis Healthcare Ltd is looking for Manager TPA Insurance to join our dynamic team and embark on a rewarding career journey- As a Manager within the Third Party Administrator (TPA) department of the insurance sector, you will play a crucial role in overseeing and managing the operations related to claims processing and administration
- Your responsibilities will include ensuring the efficient handling of insurance claims, adherence to regulatory requirements, and maintaining high standards of customer service
- Additionally, you will be responsible for leading a team of professionals, implementing process improvements, and collaborating with internal and external stakeholders to achieve departmental objectives
- Team Leadership: Provide effective leadership and supervision to a team of claims administrators and support staff, fostering a positive work environment and ensuring productivity and performance targets are met
- Claims Processing: Oversee the end-to-end process of insurance claims handling, including claim intake, assessment, investigation, adjudication, and settlement, ensuring accuracy, efficiency, and compliance with company policies and regulatory guidelines
- Quality Assurance: Establish and enforce quality assurance measures to ensure the accuracy and completeness of claims documentation, adherence to service level agreements (SLAs), and compliance with industry standards and regulations
- Client Relationship Management: Serve as the primary point of contact for clients, brokers, and other stakeholders regarding claims-related inquiries, escalations, and resolution of issues, maintaining strong and positive relationships to enhance client satisfaction and retention
- Performance Monitoring: Monitor key performance indicators (KPIs) and metrics related to claims processing, such as claims turnaround time, accuracy rates, and customer satisfaction scores, and implement strategies to improve performance and efficiency
- Regulatory Compliance: Stay updated on relevant laws, regulations, and industry trends affecting insurance claims administration, ensuring compliance with state, federal, and industry-specific regulations, such as HIPAA and GDPR
- Process Improvement: Identify opportunities for process optimization, automation, and streamlining of workflows within the claims administration process, collaborating with cross-functional teams to implement best practices and enhance operational efficiency
- Training and Development: Provide ongoing training, coaching, and professional development opportunities to claims staff to enhance their skills, knowledge, and capabilities in claims handling and customer service
- Vendor Management: Collaborate with external vendors, including medical providers, investigators, and legal professionals, to facilitate the resolution of complex claims issues and ensure cost-effective and timely service delivery
- Reporting and Analysis: Prepare and analyze reports on claims activity, trends, and performance metrics, presenting findings to senior management and stakeholders, and making recommendations for improvement and strategic decision-making
Job Classification
Industry: Medical Services / HospitalFunctional Area: Medical Services / Hospital
Role Category: Life Insurance
Role: Insurance Operations Manager
Employement Type: Full time
Contact Details:
Company: FortisLocation(s): Multi-City, India
Keyskills: insurance tpa marine insurance health insurance insurance claims insurance operations claim settlement sales broking claims processing motor insurance operations underwriting claims management claims general insurance insurance management finance
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