Claims Specialist

2 days ago

Thane, India Livlong 365 Full time
Job Title : Senior Executive - Wellness OPD Claims
Experience Required : 1+ years
Location : Thane
Job Overview :
We are looking for a Senior Executive – Claim Processing to join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company guidelines, insurance regulations, and industry standards. If you are detail-oriented, proactive, and passionate about driving efficiency and quality, we want to hear from you
Key Responsibilities :
Manage the OPD claims process, ensuring adherence to company policies, product guidelines, and insurance regulations.
Handle all queries, requests, claim rejections, escalations, and grievances with effective resolution.
Ensure the timely and accurate closure of all claims within the stipulated TAT (Turnaround Time) and SLAs (Service Level Agreements).
Implement quality control measures to scrutinize OPD claims and minimize the company’s risk exposure.
Liaise with customers, external vendors, and relevant stakeholders to ensure smooth and accurate processing of claims.
Detect and prevent fraud, waste, and abuse, while building triggers to strengthen systems and processes.
Ensure strict compliance with process guidelines, legal requirements, and regulatory standards.
Skills and Competencies :
Strong analytical thinking and problem-solving abilities.
Proactive with a results-oriented mindset.
Exceptional interpersonal and communication skills .
A customer-centric approach with attention to detail.
Ability to handle complex issues and ensure smooth end-to-end claims processing.
Qualifications :
BAMS/BHMS with strong knowledge of medical terminology, diseases, treatments, and medical guidelines.
Relevant experience in insurance claims processing, including MIS , Excel , and PPT .
MBA in Healthcare (preferred, but not mandatory).
Why Join Us?
Opportunity to work with a fast-growing and dynamic team.
Exposure to industry-leading processes and systems.
A supportive and collaborative work environment.

  • Claims specialist

    21 hours ago

    Thane, India Livlong 365 Full time

    Job Title : Senior Executive - Wellness OPD ClaimsExperience Required : 1+ yearsLocation : ThaneJob Overview :We are looking for a Senior Executive – Claim Processing to join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company guidelines, insurance...

  • Claims Specialist

    2 days ago

    Thane, India Livlong 365 Full time

    Job Title : Senior Executive - Wellness OPD ClaimsExperience Required : 1+ yearsLocation : ThaneJob Overview :We are looking for aSenior Executive – Claim Processingto join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company guidelines, insurance...

  • Claims Specialist

    2 days ago

    Thane, India Livlong 365 Full time

    Job Title: Senior Executive - Wellness OPD ClaimsExperience Required: 1+ yearsLocation: ThaneJob Overview:We are looking for a Senior Executive – Claim Processing to join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company guidelines, insurance...

  • Claims Specialist

    3 days ago

    Thane, India Livlong 365 Full time

    Job Title: Senior Executive - Wellness OPD ClaimsExperience Required: 1+ yearsLocation: ThaneJob Overview:We are looking for a Senior Executive – Claim Processing to join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company guidelines, insurance...

  • Claims Specialist

    2 days ago

    Thane, India Livlong 365 Full time

    Job Title : Senior Executive - Wellness OPD Claims Experience Required : 1+ years Location : Thane Job Overview : We are looking for a Senior Executive – Claim Processing to join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company guidelines,...

  • Claims Specialist

    3 days ago

    Thane, India Livlong 365 Full time

    Job Title : Senior Executive - Wellness OPD Claims Experience Required : 1+ years Location : Thane Job Overview : We are looking for a Senior Executive – Claim Processing to join our dynamic OPD (Outpatient Department) Wellness Operations team. The ideal candidate will have strong experience in managing OPD claims in line with company...

  • Gb Caims

    5 months ago

    Thane, India WTW Full time

    Great Britain - Claims, a line of business within the Corporate Risk and Broking segments operates to deliver the best client outcomes by fully integrating and mobilising Willis Towers Watson’s relationships with their Clients, third parties and insurers / reinsurers and providing specialist expertise throughout the client experience. Our services...

  • Buying professional

    6 months ago

    Thane, India Siemens Limited Full time

    Smart infrastructure from Siemensmakes the world a more connected and caring place – where resources are valued,where impact on the world is considered, where sustainable energy is deliveredreliably and efficiently. It provides the flexible infrastructure to allowsociety to evolve and respond to changing conditions. Technology and theingenuity of people...

  • Application Support Engineer

    2 months ago

    Thane, India Cover-More Full time

    Job Category: IT Are you ready to grow your career in our global tech hub? Cover-More Group helps people travel safely across the globe every day. We are there at every step of a traveller’s journey, to keep them safe and help them out if something goes wrong. We are committed to providing reliable, fast, flexible and bespoke services for our...