
Claims Process Specialist
3 days ago
We are seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers.
- Role Overview:
- Manage the complete lifecycle of health insurance claims, including verification, documentation, submission, follow-up, and settlement.
- Assist and guide customers through the claims journey, ensuring forms and documents are accurate, complete, and submitted promptly.
- Collaborate with insurers, third-party administrators (TPAs), and hospitals to ensure quick and accurate claim resolutions.
- Handle escalations, rejections, and disputes by investigating discrepancies, clarifying benefits, and negotiating fair outcomes for clients.
- Ensure claims handling aligns with regulatory guidelines, insurer protocols, and internal compliance standards.
- Track claim turnaround times, analyze claim outcomes, and prepare periodic reports on performance and trends.
- Identify inefficiencies in claims workflows and recommend process enhancements to improve speed, accuracy, and customer satisfaction.
Requirements:
- Education: Bachelor's degree in Business, Finance, Insurance, or related field.
- Experience: 3–6 years of proven experience in health insurance claims management or related roles.
- Certifications: IRDAI Health Insurance certification or equivalent preferred.
Skills:
- Strong knowledge of health insurance policies, products, and claims procedures.
- Excellent communication, negotiation, and customer-handling skills.
- High attention to detail with strong analytical and problem-solving abilities.
- Proficiency in MS Office and claims management/CRM systems.
Attributes:
- Customer-first mindset with empathy and professionalism.
- Ability to work under pressure and meet strict deadlines.
- Strong organizational skills and accountability.
Why Work With Us?
- Our team is dedicated to providing guidance, not pressure—helping families make confident decisions.
- Be part of creating a new vertical from scratch at a fast-growing fintech company.
- We prioritize trust & transparency, ensuring customer-first service and honesty.
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