Claims Reimbersement Manager

Role Summary:

We are looking for a driven Claims Manager to lead the Reimbursement Claims department, overseeing end-to-end claim operations, TAT adherence, insurer coordination, and process governance. This role is ideal for a high potential graduate from a premier engineering institute (IIT / NIT / BITS) with 1-2 years of experience, looking to build a career in health insurance operations and claims management. The ideal candidate combines strong analytical rigor with hands-on process ownership, building and enforcing SOPs that scale claim operations across corporate accounts.

Key Responsibilities:

• Department Management: Manage the end-to-end Reimbursement Claims department, overseeing daily claim volumes, team productivity, and overall operational output.

• TAT Adherence: Own and monitor claim adjudication turnaround times (TAT); design and enforce controls to ensure claims are processed within defined SLAs across all corporate accounts.

• Insurer Coordination: Serve as the primary point of contact for insurer partners; drive resolution of adjudication queries, escalations, and reconciliation discrepancies.

• SOP Setup & Process Governance: Design, document, and implement SOPs for claim intake, adjudication, escalation handling, and debit note issuance; drive continuous process improvement.

• Escalation Management: Own critical AM and insurer escalations; ensure timely root-cause analysis and permanent resolution to prevent recurrence.

• Team Leadership: Lead, mentor, and performance-manage a team of claims specialists and team leads; set OKRs and track individual and team performance.

• Reconciliation & Reporting: Ensure accurate daily, weekly, and monthly claim reconciliation; present operational MIS and dashboards to leadership.

• Cross-functional Coordination: Partner with Product, Tech, and Vendor Management teams to drive automation and system improvements in the claims workflow.

Qualifications:

• B.Tech / B.E. or equivalent degree preferrably from a premium institute
• 1-3 years of professional experience (any industry)
• Proven experience in managing or mentoring team
• Prior exposure to operations, analytics, or process driven roles preferred
• Health insurance / TPA / claims background is a plus, not mandatory

Skills Required:

• Strong analytical and problem-solving skills
• Process design and SOP documentation
• Advanced Excel / data analysis
• Stakeholder and insurer coordination
• Team leadership and performance management
• Ownership mindset with bias for execution