Role & responsibilities
Adjudicate medical claims across both Cashless and Reimbursement channels as per policy terms and conditions.
Review and validate claim documents to determine admissibility and liability.
Assess and determine accurate claim payouts.
Ensure compliance with internal guidelines, underwriting norms, and regulatory requirements.
Coordinate with hospitals/service providers, and internal stakeholders for claim resolution.
Identify discrepancies, red flags, and suspected fraudulent claims, and escalate as required.
Maintain high accuracy and quality standards in claim assessment and decision-making.
Support audits, compliance reviews, and management reporting related to claims.
Drive customer satisfaction through timely claim processing and effective query resolution.

Preferred candidate profile
Graduation is mandatory
Must have minimum 2 years of health claims processing experience
Freshers are not eligible for this role
Must be okay with work shift on roster basis and adaptable week-offs

📌 Walk In Manager Health Claims Non Medical Noida
🏢 TATA AIG General Insurance Company
📍 Noida