Claim Assessment & Processing: Evaluate claims (cashless/reimbursement) as per policy terms, medical documents, and regulatory guidelines, ensuring accurate adjudication.
About the Role
Coordination & Communication: Liaise with TPAs and internal teams; issue queries, approvals, and repudiation communications in a timely to TPA & Customer.
Responsibilities
- Compliance & Documentation: Ensure adherence to SOPs, IRDAI norms, and maintain complete audit-ready documentation with proper record of all claim actions.
- Quality & TAT Management: Process claims within defined turnaround time as per regulatory & internal guidelines while maintaining high accuracy and minimizing errors or rework.
- Issue Resolution & Escalation Handling: Address discrepancies, investigate suspicious cases, and escalate critical matters promptly to ensure effective resolution.
Qualifications
BHMS; MBBS
📌 Manager - Health Claims (Mumbai)
🏢 Magma General Insurance
📍 Mumbai
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