Job DescriptionAbout the Company

NClaim Assessment & Processing: Evaluate claims (cashless/reimbursement) as per policy terms, medical documents, and regulatory guidelines, ensuring accurate adjudication.

NAbout the Role

nCoordination & Communication: Liaise with TPAs and internal teams;

issue queries, approvals, and repudiation communications in a timely to TPA & Customer.

NResponsibilities

n

N
Compliance & Documentation: Ensure adherence to SOPs, IRDAI norms, and maintain complete audit-ready documentation with proper record of all claim actions.
N
Quality & TAT Management: Process claims within defined turnaround time as per regulatory & internal guidelines while maintaining high accuracy and minimizing errors or rework.
N
Issue Resolution & Escalation Handling: Address discrepancies, investigate suspicious cases, and escalate critical matters promptly to ensure effective resolution.
N

nQualifications

nBHMS;

MBBS

📌 Manager Health Claims Alibag
🏢 Magma General Insurance
📍 Alibag