Functional Role of an Insurance Claims Manager is to settle insurance claims in an insurance company. Duties of Insurance Claims Manager is to monitor the claims process and ensure that claims are processed fairly, efficiently, and in compliance with industry regulations and company policies etc. They are responsible for managing the claims team, evaluating claims, negotiating settlements, ensuring compliance, developing policies and procedures, analysing claims data, and building and maintaining relationships with stakeholders.
Do you want to know in detail what an Insurance Claims Manager does? What you should look for in an Insurance Claim Manager Resume? What are the points you should include in your Insurance Claim Manager CV? Please read below.
Responsibilities of Insurance Claims Manager:
- Handling cashless, reimbursement and investigation for suspected claims.
- Surprise visits to hospitals to validate the cashless claim for pre-existing diseases, fraudulence
- Handling Marketing team escalations related to cashless and reimbursement claims and clients’ grievances and issues.
- Handling issues with hospital relating to violation of ANH packages, bundling of procedures, overbilling negotiation with hospital staff to revise the bills and clients’ issue with hospital
- Assessing hospital claims data, billing errors, reasonable cost inflated bills
- Reporting to in house research analysis wing with inputs
- Maintaining Good relations with hospitals and regular visit to the hospitals for cashless claims
- Medical approval and billing of the claims for cashless allocated for pre authorization, final enhancement
- Scrutiny of cashless claims for pre-authorization if any insufficient documents provided initiation of query
- Cashless claims processing for enhancement approval review the final bill with discharge summary and supporting investigation reports relevant to diagnosis
- For Suspicious claims initiate for investigation (regional vigilance officer).
- Check conformity require additional documents require for processing.
- Handling of grievance claims to provide the medical opinion and processing of rejection reconsideration and deduction reconsideration related claims payable or not.
- Medical underwriting for various retail health policies based on the respective policy conditions in view of the medical records.
- Health Underwriting Training for updating the IMDs for the current policies as well as upcoming policies.
How to become an Insurance Claims Manager:
Educational Qualification requirement for an Insurance Claim Manager is Graduate or Bachelor degree from any of college/university in any medical profession or a Doctor for health insurance claims and Insurance Professional Certification Course from Insurance Institute of India for general insurance claims.
Technical Skills Required for Insurance Claims Manager:
- Strategic Planning & Leadership
- Knowledge of insurance products, policies.
- Claims processing systems
- Legal knowledge
Software skills Required for Insurance Claims Manager:
MS-Word, MS-Excel, MS-Power Point
Soft skills Required for Insurance Claims Manager:
- Excellent Verbal communication skills, both written and oral.
- Strong communicative and interpersonal skills essential for managing people.
- Self-motivated, hardworking. Always keen on constant improvement.
- Goal Oriented mind set.
What is the Job Opportunity of Insurance Claims Manager in the industry?
Given the importance of insurance claims management, there is always a high demand for qualified and experienced professionals in this field. Insurance companies need to ensure that their claims process is handled promptly and accurately, to maintain customer satisfaction and loyalty. Moreover, the insurance industry is expanding globally, and new insurance products are being introduced in the market. As a result, the demand for Insurance Claims Managers is expected to remain high in the coming years.
Salary of Insurance Sales Manager (in India):
Average Salary of Insurance Claims Manager in India starts from 5 Lacs Rupees to 15 Lakhs Rupees per annum. depending upon the Experience, Expertise, Industry, Business volume etc.
Yes, he/she needs to be a Graduate or a doctor (for health insurance)
There are very low demands Insurance Claims Managers abroad