Job Responsibilities:

- Apply medical knowledge to evaluate health insurance claim files and determine medical admissibility.
- Review and interpret policy wordings, terms, and conditions to adjudicate claim approvals or rejections.
- Process claims in accordance with regulatory and organizational guidelines.
- Ensure adherence to defined Turnaround Times (TATs) for claim processing.
- Conduct quality reviews of processed claims to maintain accuracy and compliance.
- Handle grievance redressal and claim-related escalations effectively.
- Identify and investigate potentially fraudulent claims.

Required Skills & Understanding:

- Preferably candidates with experience in Insurance or TPA (Third Party Administrator) operations.
- Strong clinical acumen and understanding of hospital processes and medical procedures.
- Knowledge of treatment protocols and diagnostic protocols.
- Ability to analyze medical records and documentation accurately.
- Positive communication and decision-making skills.

Work Requirements:

- Ready to work from the office (No Work From Home).
- Flexible to work in rotational shifts.
- Comfortable with rotational weekly offs.

Freshers and experienced BAMS/BHMS candidates are encouraged to apply.

📌 Walk-in || Claims Manager (Hyderabad)
🏢 TATA AIG General Insurance Company
📍 Hyderabad