Claims Manager

• Plan resources, manage and control overall claims processing operations for health care service providers and insured member direct claims ensuring benchmarks are met regarding execution of the different steps in the value chain for claims management proactively reducing cycle time, ensuring provision of prompt services to clients, and thus supporting achievement of the overall MedNet goals and objectives and optimum customer satisfaction.
• Settle claims as per prescribed/designated financial authorities; ensure reserves are established/maintained for reported claims as per agreed procedures and review of claims is taken up periodically.
• Ensure prompt communication with the General Manager for claims exceeding the defined limits and forward cases of large claims to the responsible manager for action.
• Monitor the process of Adjudicate and medical evaluate claims accurately performed by the claims team.
• Supervise Claims team when it comes to applying & maintaining quality measures for all processed claims.