Manager / Sr. Manager
Manager / Sr. Manager
Posted on :
24-07-2025
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1 Vacancy
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Job Description
TPA Management
Establish and manage relationships with Medical TPAs (e.g. Mediassist Health India) for outsourced medical testing operations; Execute / renew contracts with TPAs after negotiating costs and agreement terms in coordination with the Legal team
Set-up define and communicate SLIC SOPs and guidelines for medical testing operations to TPAs; Ensure SLAs and activity wise TATs are clearly understood and agreed by TPAs
Review and finalize mapping of empanelled Diagnostic Centers in coordination with TPAs; Ensure availability of medical testing facilities for all SLIC branches / locations
Review and monitor TPA service levels and adherence to SOPs on a continuous basis; Ensure TATs for medical registration uploading medical reports submission of original reports etc. are maintained
Plan and organize Mystery Shopping audits at Diagnostic Centers in coordination with branches / divisional offices; Review audit feedback regarding quality of service adherence to SOPs and escalate issues / lapses with concerned TPAs
Review and monitor medical pendency cases across branches / divisional offices / channels; Drive closures of pending cases through active follow ups with branch / divisional offices and TPAs
Review and validate TPA invoices obtain payment approvals and coordinate with Accounts for processing payments; Ensure all payments are disbursed accurately and on time
Manage Tele / Video Underwriting Operations
Establish set-up and revise SOPs checklists and scripts for tele / video calling processes (e.g. underwriting
/ fraud detection medical test feedback grievance renewals agent verification)
Collate cases from Underwriting team and plan work allocations to effectively manage tele/ video calling
volumes
Allocate cases and share case data dumps to team members for various calling processes (e.g.
underwriting / fraud detection very high risk medical test feedback grievance agent verification)
Ensure completion of daily calls and updation of forms / questionnaires in adherence to SOPs and defined
timelines; Conduct random audits / checks to monitor quality and effectiveness of tele / video calls
conducted by team
Report and discuss negative findings / fraud cases with Underwriting team; Analyse fraud cases to identify
common patterns / trends and provide inputs for revising underwriting norms & guidelines
MIS Reports & Data Analytics
Ensure MIS and reports (e.g. medical pendency case status trackers TPA adherence to TAT etc.) are
prepared and circulated to internal and external stakeholders (e.g. branches / divisional offices / channels /
TPAs) as per prescribed formats and timelines
Perform data analytics and mining to generate insights regarding risk factors negative locations DC
feedback etc.; Report and discuss findings with Manger to take appropriate preventive actions to mitigate
SLICs risks
Support IT Projects & Audits
Coordinate with the IT team for new system / module developments change / enhancement requests and
UATs pertaining to the Underwriting function
Provide data support for all audits (internal IRDA) and respond to all audit queries and clarifications raised
Team Management
Set clear expectations by communicating Tele / Video calling objectives guidelines SOPs and timelines to
team members. Review performance of team members and provide on-going feedback
Train the team on conducting effective tele / video calls identifying & detecting frauds etc.; Provide
guidance to team on specific cases queries and escalations
Employment Type
Full-time
Key Skills
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