Health Insurance Claims Manager jobs

Job Description

Position

Deputy Manager– Claims

No. of Positions

1Department

Operations-ClaimsFunctionClaimsReporting to

Chief Manager – ClaimsBand5Location

Gurgaon HOLast date of submissionRequirements Gathering:
Participating in Evaluation of requirements
Works closely with stakeholders to understand their objectives and translate these into system specifications that guide development and implementation.
Create use cases that illustrate user interactions with the system, ensuring all scenarios are covered.
Analysis and Design
Analyze current systems and processes to identify areas for improvement.
Assess the impact of proposed changes on existing systems and processes, identifying potential risks and mitigation strategies.
Facilitate sessions to validate designs with users, ensuring that their feedback is integrated into the final design.
Participate in design review meetings to ensure that solutions align with business needs and architectural standards.
Create and maintain comprehensive documentation, including user manuals and training materials.
Design new processes that align with business goals, incorporating best practices and compliance requirements
Automating workflows ensure that processes run smoothly and consistently, minimizing delays and bottlenecks.
BRMS rule built in claim system based on product benefits.

Business Requirement writing Testing and Quality Assurance:
Preparation/Reviewing the BRD and FSD for functionalities to be build
BR CR writing and FSD review
Testing of functionalities, test plans and conduct user acceptance testing (UAT management)
Develop and execute test plans to validate system functionality against requirements
Ensure that solutions meet business needs and validate system functionality.
Facilitating cross functional alignment governance reviews
Knowledge transfer - Repository creation and management as per plan
Conduct training sessions for end-users on new systems and processes.
Provide ongoing support and troubleshooting for system-related issues
Establish mechanisms for collecting feedback on system performance and usability post-implementation.
Collect feedback post-implementation to identify areas for further enhancement
Stay updated on industry trends and best practices to recommend improvements
Adherence to Project calendar
Adherence to submission of Ops deliverables as per project calendar.
Serve as a liaison between business units and IT, ensuring effective communication and understanding.
Product launch requirements handling go live of the requirements before 3 months of the hit date.
Zero defect post production due to incomplete BR
Support project managers in planning and executing projects
Monitor project progress, ensuring alignment with requirements and timelines.
Provide ongoing support and clarification of requirements throughout the project lifecycle
Compliance
Strengthening control compliance with all transactions in Claim System.
Reconciliation of income payouts and system transactions.
Identification of key process / product parameters having a financial or customer impact
Facilitating deployment of prioritized SIC's
No major outage in any other audit
People
Strengthen people capability and Growth agenda
Overall Attrition
G2M2 Attrition
Pulse/Tower Watson Score
Development Plan
Develop second line of resource
Cost
Work within the allocated budget, amount saved from last year budget.