Head - Claims, FWA and Retail UW
Rs 20 per hourFull-time
Recruitkar
Lead - Claim QC & Audit, Case Management
Department: Claims
Designation of the Manager: Head – Claims, FWA and Retail UW
Location: Thane (Onsite)
The role is responsible for ensuring accuracy, compliance, and quality in claims processing across
both inhouse and TPA units. It involves concurrent and retrospective audits of cashless and
reimbursement claims, covering indemnity and fixed benefit types. The position safeguards process
integrity by identifying errors, mitigating risks, and driving corrective actions, while strengthening
governance, compliance, and customer trust.
• Claims Quality Check
Quality check of processed claims Inhouse+ TPA (Concurrent/ Retrospective audit)
Processing Unit - Inhouse and TPA Cashless and Reimbursement Benefit Type - Indemnity
and fix benefit Review of FWA closure quality Sample investigation of send back claims.
• High value Audit of Cashless & Reimbursement Claim
100% review of Claim with amount as below Indemnity claims above 5 Lakh Fix benefit
above 20 Lakh Early claims within 1-2 team policy inception (New business/Port) Review of
UW policy impact on claims Review of Product benefit on claim incidence rate Review of
System related rules & validation Audit of NEFT/Payment process Assess compliance with the
latest industry standards and regulations Audit of Clinical coding for accurate system
adjudication and data analytics Boost documentation and reporting accuracy
• Review of Tarrif & Identify abuse and renegotiation of tarrif
Review of Provider tariff Review of Non package illness and help provider team for creation
of packages. Review of existing packages, identify abuse and renegotiation
- Domain: Insurance
- Employment type: Full-Time
- Work mode: Remote · Thane
- Experience: 10–18 years
- Compensation: INR 2,00,000–3,50,000 /month
Vacancy posted more than 2 months ago
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