Industry: Health Insurance / TPA / Insurance / Financial Services
Key Responsibilities:
Manage end-to-end health insurance claim processing, from claim intimation to settlement/rejection.
Handle cashless and reimbursement claims and ensure timely processing.
Coordinate with TPAs, insurance companies, hospitals and customers regarding claims.
Review claim documents, medical records and policy coverage for eligibility.
Monitor claim status, pending cases, repudiations and settlement timelines.
Resolve customer and hospital queries related to health insurance claims.
Ensure compliance with IRDAI guidelines, company policies and claim procedures.
Identify discrepancies, potential fraudulent claims and escalate as required.
Prepare daily/weekly/monthly claims MIS and performance reports.
Lead and monitor the claims team to achieve TAT and service-level targets.
Coordinate with internal teams for claim documentation, approvals and settlements.
Mandatory Candidate Profile
3+ years of relevant Health Insurance Claims experience.
Experience in Health Insurance / TPA / Hospital Insurance Desk / Insurance Claims Operations.
Valuable understanding of cashless, reimbursement, pre-authorization and claim settlement processes.
Experience handling hospitals, TPAs and insurance companies.
Positive communication, coordination and team-management skills.
Kindly below experience profiles to avoid:
Motor Insurance Claims
Vehicle/Auto Claims