
Insurance Claim Processor
1 day ago
About the Position:
We are seeking a highly organized and detail-oriented Claims Management Specialist to join our team. As a Claims Management Specialist, you will be responsible for processing and managing cashless insurance claims efficiently and accurately.
The ideal candidate will have excellent communication skills, a strong attention to detail, and the ability to work in a fast-paced environment. You will be responsible for verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently.
Key Responsibilities:
- Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and coordinating with Insurers.
- 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 related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details when required.
- Resolve Issues: Investigate and resolve any discrepancies, errors, or issues that may arise during the processing of cashless claims.
- 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.
Requirements:
- At least 2 years of experience in customer-facing roles
- Past Experience in voice profile would be an added advantage
- Experience in cashless/ TPA
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