Medical Reviewer Job at Principal Financial Group
A rare opportunity has emerged for professionals in the insurance sector: Principal Financial Group is seeking an Assistant Manager, Operations – Claims in Pune, India. This Medical Reviewer Job offers a blend of in-office and remote work, making it an appealing opportunity for qualified candidates.
About Principal Financial Group:
Principal Financial Group is a leading global financial services company that specialises in providing a range of insurance and investment solutions. With a commitment to innovation and customer satisfaction, the organisation operates in various sectors, including health insurance, life insurance, and investment management. Principal Financial Group is dedicated to fostering a diverse and inclusive workplace that values the contributions of every team member.
Job Details:
- Reference Number: 52093
- Department: Claims
- Employment Type: Regular Full-Time
- Location: Pune, India
- Work Arrangement: In-office a few days a week (a minimum of 3 days in office) and Work from Home
- Shift Timings: 1.30 to 10.30 PM (During Training 5.30 – 2.30 PM, which is for 3 months)
Job Description:
The Assistant Manager, Operations – Claims, will oversee the dental claims function, ensuring compliance with policies and state and federal regulations. This role requires a deep understanding of claims procedures and the ability to analyse claim details effectively. The successful candidate will also be responsible for training and mentoring team members, fostering a culture of innovation, and facilitating communication within the team.
Key Responsibilities:
- Manage the dental claims function in strict accordance with policy, state, and federal laws and regulations.
- Analyse claim details and apply knowledge of claims procedures, product development, contract provisions, and regulations to ensure accurate and timely claim decisions.
- Understand plan provisions, determine eligibility, verify data input, identify accurate benefit levels, coordinate benefits, and make necessary corrections.
- Build, develop, coordinate, and conduct training programs for individuals and teams, both large and small scale, in this Non-Clinical Job.
- Manage training and mentoring, ensuring detailed reporting of team and individual training progress to superiors.
- Communicate company strategy, goals, and deadlines to team members, motivate them, and assess their performance.
- Facilitate communication of concerns and policies between management and team members.
- Coordinate effective collaborator management, new migrations, customer happiness, and operational risk management.
- Foster a culture of innovation and process simplification.
Eligibility Criteria for the Medical Reviewer Job:
- Bachelor of Dental Surgery (BDS), Bachelor of Ayurvedic Medicine and Surgery (BAMS), or Bachelor of Homoeopathic Medicine and Surgery (BHMS), or equivalent experience.
- Minimum of 10 years’ experience in back office operations within insurance, preferably with domestic insurers or abroad.
- Experience in claims processing of health insurance, life, and disability claims is preferred.
- Proficient in MS Office with excellent written and verbal communication skills.
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