Claims Specialist

2 days ago

bangalore district, India Plum Full time

About Job:-

Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers.

The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently. The processor may also be responsible for communicating with employees or dependants to provide updates on the status of their claims and to address any questions or concerns. Overall, the job purpose is to facilitate the smooth and timely processing of cashless claims to ensure that employees receive the benefits they are entitled to.

PRINCIPAL ACCOUNTABILITIES:-

  • Act as a Claims buddy - Manage end-to-end cashless claims of employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently.
  • Verify Policy Coverage: Review and verify policy details to ensure that the claim is eligible for cashless processing according to the terms and conditions of the insurance policy.
  • Provide Customer Service: Respond to inquiries from employees, and other stakeholders regarding claim status, and any other related queries.
  • Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers
  • to obtain additional information, clarify details,( whenever required)
  • Resolve Issues: Investigate and resolve any discrepancies, errors, or issues that may
  • arise during the processing of cashless claims to ensure timely and accurate resolution
  • Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
  • Adhere to Service Level Agreements: Meet or exceed established service level
  • agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
  • Achieve NPS of 92+ in the cashless claims handled

INTERACTIONS:-

-Internal Clients:

  • Endorsement team
  • Onboarding team
  • Products & engineering-
  • Claims teams
  • Support Inbound
  • Account Management

-External Clients:

  • Insurers
  • Client HR’s
  • Hospitals

Who can apply?

  • At least 2 years of experience in customer-facing roles
  • Past Experience in voice profile would be an added advantage
  • Experience in cashless/ TPA

  • Claims specialist

    5 days ago

    Bangalore, India Plum Full time

    About Job:- Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers. The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes...

  • Claims Specialist

    1 week ago

    bangalore, India Plum Full time

    About Job:-Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers.The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes verifying...

  • Carrier/Merchant Claim Specialist

    6 days ago

    bangalore, India BolsterBiz Full time

    Company DescriptionBolsterBiz is a leading provider of offshoring and outsourcing services based in New Delhi. We specialize in driving business growth, optimizing operational efficiency, and ensuring long-term success. With over 2,000 completed projects and more than 100 clients in the USA, we offer cost-effective solutions with access to expert...

  • [Immediate Start] Claims Resolution Specialist

    5 days ago

    Bangalore, Karnataka, India Transworld Systems Full time

    Overview Please Note English language proficiency is required for this role This is a full-time work from office role This requires a U S schedule - India Night shift Work Location This is a Work from Office position and location is Bangalore at Block 12B Pritech Park 3rd Floor SEZ Survey No 51-64 4 Bellandur Village Bldg 9A Rd Bengaluru...

  • Analyst /Specialist / Sr Specialist - Insurance Follow Up (AR)

    7 days ago

    Mumbai City District, India Health Prime Services Full time

    Designation - Analyst/Specialist /Sr Specialist - Insurance Follow Up (AR Denials) Work Location - Andheri East Role & responsibilities Checking denials from EOBs, ERAs by calling the Insurance Companies. Calling the insurance companies for the specification of denials. Reprocessing the claim over the phone or reopening the claims on the online portals...

  • Billing Specialist

    1 week ago

    bangalore, India Care365 SOL Private limited Full time

    Company DescriptionCompany: Care365 SOL INCLocation: Permanent RemoteSchedule: Full-TimeIndustry: Homecare Billing & AdministrationCare365 SOL INC is seeking a skilled and detail-oriented Billing Specialist to join our team full-time in a fully remote role. If you have experience in homecare billing and thrive in a proactive, organized environment, we’d...

  • QA Specialist

    2 weeks ago

    Pune, Chennai, Bengaluru / Bangalore, India beBeeTester Full time ₹ 15,00,000 - ₹ 28,00,000

    We are seeking an experienced QA Tester to join our team for a Guidewire Claims Center (GWCC) implementation.7+ years of experience in IT, with 5+ years in GWCC testing is required.Offshore location is available.Immediate start date is preferred.Role Summary:As a QA Tester, you will be responsible for performing end-to-end testing of GWCC implementations....

  • Insurance Underwriting Specialist

    2 days ago

    bangalore, India Swan Corp Full time

    Insurance Underwriting Specialist Job Title: Insurance Underwriting Specialist Location: Mumbai/Remote Employment Type: Full-Time Experience Required: 3-5 years in agriculture insurance underwriting or a related field Education: Bachelor's degree in Agriculture, Risk Management, Insurance, or a related field. Job Overview: We are seeking an...

  • Experienced Billing RCM

    2 days ago

    bangalore, India My Care International Full time

    Position : Experienced Billing RCM (Physicians/Hospital/Lab) Location : Remote Experience : 3 to 5 years Shift time : 07:30 pm to 05:30 am IST (10 Hour Night Shift) Workdays : 5 working days Salary: 35+ Company Overview: My Care Labs is a leading laboratory specializing in wellness and toxicology testing, committed to providing accurate and...

  • Experienced Billing RCM

    1 week ago

    bangalore, India My Care International Full time

    Position: Experienced Billing RCM (Physicians/Hospital/Lab)Location: RemoteExperience: 3 to 5 yearsShift time: 07:30 pm to 05:30 am IST (10 Hour Night Shift)Workdays: 5 working daysSalary: 35+Company Overview: My Care Labs is a leading laboratory specializing in wellness and toxicology testing, committed to providing accurate and timely results to support...