We are looking for a Claims professional to manage Travel and OPD health insurance claims. The candidate will be responsible for claim audits, claim processing, MIS reporting, and ensuring timely claim settlement while coordinating with external partners.
Key Responsibilities:
Review and audit Travel & OPD claims.
Coordinate with TPAs and service partners for claim settlement.
Prepare and maintain MIS reports using Excel.
Ensure claims are processed within defined TAT and SLA.
Monitor claim quality and resolve audit observations.
Work with internal teams and external partners for process improvements.
Required Skills:
Claims Processing
Health Insurance Claims
Travel Claims / OPD Claims
Medical Claim Audit
Advanced Excel & MIS Reporting
TPA Coordination
Valuable Communication Skills
Attention to Detail
Preferred Candidate:
MBBS / BAMS / BHMS graduates.
2–5 years of experience in Health Insurance Claims.
Positive knowledge of medical terminology and claim adjudication.
Robust Excel and analytical skills.
📌 Claims Executive Mumbai (India)
🏢 TopGear Consultants
📍 India
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