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.
Robust 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.
Valuable communication and decision-making skills.

Work Requirements
Ready to work from the office (No Work From Home).
Adaptable 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 (India)
🏢 TATA AIG General Insurance Company
📍 India