Insurance Claim Processor

15 hours ago


Solapur, Maharashtra, India beBeeClaims Full time ₹ 10,00,000 - ₹ 15,00,000
Job Description

Our organization is seeking a Claims Specialist to join our team. This role involves processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers.

The ideal candidate will have excellent communication skills to communicate with employees or dependants regarding claim status and address any questions or concerns.

Key Responsibilities:
  1. Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and coordinating with Insurers.
  2. 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.
  3. Provide Customer Service: Respond to inquiries from employees and other stakeholders regarding claim status and related queries.
  4. Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information, clarify details, and resolve issues.
  5. Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
  6. 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.
Interactions:
  • Internal Clients: Endorsement team, Onboarding team, Products & engineering, Claims teams, Support Inbound, Account Management
  • External Clients: Insurers, Client HR's, Hospitals


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