Claims Processor

About the Role:

The Claims Processor plays a pivotal part in managing and processing cashless insurance claims with precision and speed, ensuring timely resolution for policyholders and seamless collaboration with insurance providers.

This position involves verifying policy coverage, reviewing medical records, coordinating with insurers, and guaranteeing accurate and efficient claim processing. The Claims Processor also communicates with employees or dependants to provide updates on claim status and address any inquiries or concerns.

Main Responsibilities:

• Claim Processing: Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring accurate and efficient processing.
• Policies Verification: 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.
• Customer Service: Respond to inquiries from employees and other stakeholders regarding claim status and related queries.
• Healthcare Coordination: Communicate with healthcare providers to obtain additional information, clarify details, and resolve issues.
• Error Resolution: Investigate and resolve discrepancies, errors, or issues that may arise during claim processing to ensure timely and accurate resolution.
• Record Maintenance: Maintain detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
• 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

Qualifications:

1. At least 2 years of experience in customer-facing roles
2. Past Experience in voice profile would be an added advantage
3. Experience in cashless/TPA

We Offer:

A dynamic work environment with opportunities for growth and development, a competitive compensation package, and a comprehensive benefits program.

Note: This job description is not an exhaustive list of responsibilities. The employer reserves the right to modify this job description as needed.