Benefits Administrator

3 days ago


Nashik, Maharashtra, India beBeeClaimsManagement Full time ₹ 8,00,000 - ₹ 15,00,000
About This Role:

The Claims Management Specialist position involves managing and processing cashless insurance claims efficiently, ensuring timely closure to policyholders and seamless coordination with insurers.

This role requires verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate claim processing. Effective communication is essential for providing updates on the status of claims and addressing any questions or concerns.

Key Responsibilities:
  1. Cashless Claim Management: Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and coordinating with Insurers.
  2. Polic Coverage Verification: Review and verify policy details to ensure eligibility for cashless processing according to policy terms.
  3. Customer Service: Respond to inquiries regarding claim status and related queries from employees and stakeholders.
  4. Healthcare Provider Coordination: Communicate with healthcare providers to obtain information and clarify details as needed.
  5. Issue Resolution: Investigate and resolve discrepancies, errors, or issues that may arise during claim processing.
  6. Record Maintenance: Maintain detailed records of claim-related activities, communications, and transactions for documentation and audit purposes.
  7. Service Level Agreement Adherence: Meet 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 profiles would be an advantage.
  • Experience in cashless/ TPA.


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