We are looking for a proactive and detail-oriented Operation Executive to join our USA Insurance TPA Process team in Gurgaon.

The selected candidate will be responsible for processing insurance claims, coordinating claim settlements, maintaining claim documentation, communicating with insurance providers and healthcare facilities, and ensuring timely claim resolution while maintaining compliance with US healthcare standards.

Candidates should possess solid analytical skills, excellent communication abilities, attention to detail, and experience working in healthcare insurance or back-office operations.

Key Responsibilities
Process USA insurance claims accurately and efficiently.
Coordinate with insurance companies, TPAs, healthcare providers, and clients for claim processing and settlement.
Review insurance claim documents for completeness, accuracy, and compliance.
Follow up on pending claims and resolve claim-related issues.
Verify patient insurance eligibility and policy coverage.
Maintain accurate claim records, documentation, and operational reports.
Handle healthcare back-office activities related to insurance processing.
Monitor claim status and ensure timely claim settlement.




Communicate professionally through email and phone with clients and insurance representatives.
Ensure compliance with company policies, HIPAA guidelines, and US healthcare regulations.
Update claim information in CRM and internal operational systems.
Prepare MIS reports and daily operational updates for management.

Required Skills
USA Insurance Process
TPA Operations
Insurance Claims Processing
Medical Claims Settlement
Healthcare Back Office
US Healthcare Process
Medical Billing
Revenue Cycle Management (RCM)
Claims Management
Documentation
MS Excel
CRM Software
Communication Skills
Analytical Skills
Attention to Detail
Time Management
Email Communication
Problem Solving

Preferred Skills
Healthcare BPO Experience
Insurance Verification
Claims Adjudication
Denial Management
AR Calling
HIPAA Compliance
Healthcare Operations
Process Improvement
Team Collaboration

Disclaimer : This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

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