Claims Control Team Member

About the role

The Claims Control Team Member will establish and maintain a robust framework for managing health insurance claims. This role ensures regulatory compliance, quality assurance, and risk mitigation while driving governance through audits, fraud prevention, and leakage control.

Key responsibilities

• Develop and sustain a claims control framework aligned with industry standards and regulations.
• Conduct regular audits and implement fraud‑prevention measures to protect the organization.
• Monitor claim leakage and implement corrective actions to reduce financial loss.
• Leverage MIS, analytics, and dashboards to generate actionable insights for continuous improvement.
• Drive process automation and efficiency initiatives across the claims lifecycle.
• Collaborate with cross‑functional teams to ensure transparent and compliant claim handling.

Required profile

Required skills