About Job

At ACKO, we are seeking an experienced and skilled professional to fill the role of Assistant Manager Health Claim Investigation. This position will be responsible for managing health claims investigations, ensuring timely and accurate resolution of claims, and maintaining high-level customer satisfaction. The successful candidate will be a strong leader who can effectively manage a team, allocate tasks, and ensure seamless communication with external vendors and internal stakeholders.

The ideal candidate will be a detail-oriented and analytical individual with a passion for delivering exceptional results. If you are a motivated and results-driven professional looking for a challenging role, we encourage you to apply for this exciting opportunity.

Skills & Qualification

• Strong knowledge of health insurance and claims investigation processes

• Excellent communication and interpersonal skills to effectively manage vendors and stakeholders

• Ability to analyze data and identify trends to improve investigation processes

• Strong problem-solving skills to resolve complex claims investigations

• Ability to work efficiently under pressure and meet deadlines

• Proficient in Microsoft Office Suite, particularly Excel, Word, and PowerPoint

• Strong leadership and management skills to effectively manage a team

• Ability to travel to carry out field investigations

Responsibilities

• Follow the Standard Operating Procedure (SOP) laid out for Health Claims Investigations

• Takes full responsibility of managing health claims investigations, including allocation of cases to external vendors, follow-up for reports, and quality control of investigation reports

• Will be willing to travel to carry out field investigations

• Ensures to get the investigation reports within the prescribed Turn-Around-Time (TAT)

• Maintains the quality of investigation reports from vendors by conducting regular quality checks

• Provides proactive assistance to the Health Claims team to achieve customer delight and high-level customer satisfaction for the insured and internal stakeholders

• Works efficiently to meet set goals and avoids any escalations to maintain relevance and quality while providing service to stakeholders

• Handles vendor management, including obtaining SLAs and documents for empanelment

• Handles projects and additional tasks assigned