Health Insurance Claims Professional

1 day ago

Bengaluru, Karnataka, India beBeeInsurance Full time ₹ 6,00,000 - ₹ 15,00,000

Job Opportunity

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We are seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers.

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In this role, you will serve as the primary liaison between clients, insurers, third-party administrators (TPAs), and healthcare providers to ensure claims are handled smoothly, accurately, and on time.

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The ideal candidate will have a strong background in health insurance claims management, excellent problem-solving skills, and the ability to deliver a seamless, customer-focused experience.

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Key Responsibilities

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  • Claims Processing & Adjudication: Manage the complete lifecycle of health insurance claims, including verification, documentation, submission, follow-up, and settlement.
  • Customer Coordination: Assist and guide customers through the claims journey, ensuring forms and documents are accurate, complete, and submitted promptly.
  • Insurance & TPA Liaison: Collaborate with insurers, third-party administrators (TPAs), and hospitals to ensure quick and accurate claim resolutions.
  • Issue Resolution: Handle escalations, rejections, and disputes by investigating discrepancies, clarifying benefits, and negotiating fair outcomes for clients.
  • Compliance & Accuracy: Ensure claims handling aligns with regulatory guidelines, insurer protocols, and internal compliance standards.
  • Monitoring & Reporting: Track claim turnaround times, analyze claim outcomes, and prepare periodic reports on performance and trends.
  • Process Improvement: Identify inefficiencies in claims workflows and recommend process enhancements to improve speed, accuracy, and customer satisfaction.
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Requirements

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Education

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  • Bachelor's degree in Business, Finance, Insurance, or related field.
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Experience

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  • 3–6 years of proven experience in health insurance claims management or related roles.
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Certifications

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  • Health Insurance certification or equivalent preferred.
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Skills

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  • 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.
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Attributes

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  • Customer-first mindset with empathy and professionalism.
  • Ability to work under pressure and meet strict deadlines.
  • Strong organizational skills and accountability.
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