Claims Specialist

About GrayQuestGrayQuest is India’s leading FinTech innovator in the education ecosystem, transforming the$100B+ education industry through its cutting-edge financial solutions. Our flagship offering—monthly EMI solutions for school and college fee payments—makes education more accessible,affordable, and rewarding for millions of Indian families.We partner with 5,000+ top educational institutions across the country, making us a trustedname in education-focused financial services. Backed by some of India’s most respectedinvestors and entrepreneurs—including Kunal Shah & Miten Sampat (CRED), Nitin Gupta (UNI),Sumit Maniyar (Rupeek), and Sujeet Kumar (Udaan)—we are now entering an exciting new Phase.As part of our strategic expansion, we’ve launched a new insurance vertical focused onproviding customised life and health insurance products to families within our network andbeyond. This is a high-impact opportunity to be at the forefront of building this vertical from theground up.Role OverviewWe are seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers. In this role, you will serve as the primary liaison between clients, insurers, TPAs, and healthcare providers to ensure claims are handled smoothly, accurately, and on time.The ideal candidate will have a strong background in health insurance claims management, excellent problem-solving skills, and the ability to deliver a seamless, customer-focused experience. This is a full-time, on-site role based in Mumbai with immediate joining.Key Responsibilities- Claims Processing & Adjudication: Manage the complete lifecycle of health insurance claims, including verification, documentation, submission, follow-up, and settlement. - Customer Coordination: Assist and guide customers through the claims journey, ensuring forms and documents are accurate, complete, and submitted promptly. - Insurance & TPA Liaison: Collaborate with insurers, third-party administrators (TPAs), and hospitals to ensure quick and accurate claim resolutions. - Issue Resolution: Handle escalations, rejections, and disputes by investigating discrepancies, clarifying benefits, and negotiating fair outcomes for clients. - Compliance & Accuracy: Ensure claims handling aligns with IRDAI guidelines, insurer protocols, and internal compliance standards. - Monitoring & Reporting: Track claim turnaround times, analyze claim outcomes, and prepare periodic reports on performance and trends. - Process Improvement: Identify inefficiencies in claims workflows and recommend process enhancements to improve speed, accuracy, and customer satisfaction.RequirementsEducation- Bachelor’s degree in Business, Finance, Insurance, or related field.Experience- 3–6 years of proven experience in health insurance claims management or related roles.Certifications- IRDAI Health Insurance certification or equivalent preferred.Skills- Strong knowledge of health insurance policies, products, and claims procedures. - Excellent communication, negotiation, and customer-handling skills. - High attention to detail with strong analytical and problem-solving abilities. - Proficiency in MS Office and claims management/CRM systems.Attributes- Customer-first mindset with empathy and professionalism. - Ability to work under pressure and meet strict deadlines. - Strong organizational skills and accountability.Why Join Us?Here’s why GrayQuest is different:- Advice First, Always: We provide guidance, not pressure—helping families make confident decisions. - Build Something New: Be part of creating a vertical from scratch at a fast-growing fintech. - Trust & Transparency: IRDAI compliance, customer-first service, and honesty are non-negotiable.