About the Company 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 (India)
🏢 Magma General Insurance
📍 India
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