Job Description Control claim cost inflation -Case Management and ACC Vendor Management Hospitals/TPAs/Investigation Agencies/KPOs and others Experience using SAS for data for reporting purposes: Eg Fraud claims triggers, fraud control and MIS Evaluate and comprehensive reports on Claims TAT both cashless and reimbursement Will be responsible for the design, development, coding, testing, debugging and documentation of applications Eg. ICD/PCS to satisfy the requirements of one or more user areas as per IRDA requirement Legal Cases Insurance Ombudsman/Consumer Forum replies with logical response and TATs Health Claims Processing Management as per SOP Health Claims Complaints Management Health Claims Audit KNOWLEDGE/SKILLS -Excellent working knowledge of Excel and communication skills -Understanding of International Health Claims a plus. ABILITIES/ATTRIBUTES -Ability to work within cross-functional teams - Excellent written/verbal communication skills - Team player with strong collaborative qualities. - Strong interpersonal, problem-solving, prioritization, decision making and conflict resolution skills - Medical/Tariff Negotiations with Providers Desired Profile QUALIFICATIONS & EXPERIENCE: -Minimum 4 - 6 years of Health Claims in TPA/Insurance Companies -MBBS / BAMS / BHMS / BUMS / BEMS -Managing a team of minimum 3-4 doctors in Insurance Companies and above 10 in TPAs -Clinical experience of 1-2 years a plus Experience 4 - 6 Years Industry Type Insurance Role Claims Manager Functional Area Financial Services, Banking, Investments, Insurance Education UG - MBBS - Medicine PG - Any Postgraduate - Any Specialization, Post Graduation Not Required Doctorate - Any Doctorate - Any Specialization, Doctorate Not Required Compensation: Not disclosed Location Bengaluru/Bangalore Keywords Fraud Control Vendor Management Claims Processing Conflict Resolution Legal Cases Consumer Forum Design Development Verbal Communication Problem Solving Contact HR Bharti AXA General Insurance Company Ltd @http://jobsearch.naukri.com/job-listings-Assistant-Manager-Health-Claims-Bharti-AXA-General-Insurance-Company-Ltd--Bengaluru-Bangalore-4-to-6-years-020715900689?xp=2&qp=bhms/bams/ayush&srcPage=s

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