Dedicated Claims Specialist

3 weeks ago

Pune, Maharashtra, India Loop Health Full time
Job Description

We are looking for aDedicated Claims Specialistwith a strong background in medical and health insurance, particularly ingroup medical corporate policies. The ideal candidate should have 2-4 years of experience in claims processing or CRM roles.

Key Responsibilities:

- Handle end-to-end processing of reimbursement claims for group medical corporate policies.
- Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk.
- Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing.
- Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions.
- Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach.
- Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing.
- Ability to understand medical terminology, treatment procedures, and health-related documentation.
- Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools.
- Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively.
- Attention to detail to ensure accuracy in claim processing and documentation review.
- Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks.
- Qualifications: Bachelor s degree in healthcare, insurance, or related field preferred.
- 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

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