Key Responsibilities:
- Document Verification: Verify policyholder eligibility, coverage, and the completeness of documents (e.g., claim form, discharge summary, medical bills, investigation reports).
- Data Accuracy: Ensure accurate data entry of patient details, diagnosis codes, and hospital information into the system.
- Inter-departmental Coordination: Coordinate with Third Party Administrators (TPAs), hospitals, and internal medical teams for smooth claim handling.
- Confidentiality & Compliance: Ensure compliance with company policies, regulatory guidelines (e.g., IRDAI), and maintain the confidentiality of medical records.
- Record Maintenance: Maintain and scan claim documents securely,
creating proper logs and reports.
Required Skills & Qualifications:
- Education: Bachelor’s degree in any discipline.
- Experience: 0-3 years of experience in insurance claims.
- Technical Skills: Proficiency in MS Excel and MS Office; familiarity with Claims Management Software is preferred.
- Domain Knowledge: Basic understanding of health insurance policies, medical terminology, and TPA procedures.