Supervise and provide daily operational support to Claim Analysts Head to ensure efficient workflow and service delivery.
Review, evaluate, and approve complex or high-value claims in accordance with policy and medical guidelines.
Monitor team performance against SLA, accuracy, and productivity.
Handle escalated cases, disputes, and critical claims with strong judgment and stakeholder coordination.
Conduct quality control reviews and continuously improve claim processes.
Actively participate in claim system development and enhancement initiatives, ensuring alignment with business needs.
Provide business and medical insights to strengthen claim rules, fraud detection, and automation processes.
Requirements:
Bachelor's Degree in Medicine.
Min. 5-6 years of experience as claim analyst in the insurance industry.
Proven experience in handling medical claims, including complex and high-value cases.
Exposure to healthcare providers, hospital billing, or utilization review is an advantage.
Required Skill(s): Strong knowledge of Medical claims assessment, Data analysis and reporting, Process improvement, Strong analytical and problem-solving abilities, Effective communication, Attention to detail and high level of accuracy and Ability to work under pressure and manage multiple priorities.
