
Senior Insurance Claims Coordinator
6 hours ago
The Insurance Claims Specialist plays a pivotal role in ensuring the efficient and accurate processing of cashless insurance claims.
This involves verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring timely closure to policyholders.
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.
Interactions:
- Internal Clients: Endorsement team, Onboarding team, Products & engineering, Claims teams, Support Inbound, Account Management
- External Clients: Insurers, Client HR's, Hospitals
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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