Cashless Insurance Claim Manager

15 hours ago

Ajmer, Rajasthan, India beBeeClaims Full time ₹ 7,00,000 - ₹ 11,00,000

Job Description:

The Claims Specialist role involves efficiently and accurately processing cashless insurance claims, ensuring timely closure to policyholders and seamless coordination with insurance providers.

This position entails verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring claims are processed accurately and efficiently. The specialist may also communicate with employees or dependants to provide updates on claim status and address questions or concerns.

Key Responsibilities:

  • Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and coordinating with Insurers.
  • Verify policy details to ensure claims are eligible for cashless processing according to insurance policy terms and conditions.
  • Provide customer service by responding to inquiries from employees and other stakeholders regarding claim status and related queries.
  • Coordinate with healthcare providers to obtain additional information and clarify details when required.
  • Resolve discrepancies, errors, or issues that may arise during claim processing to ensure timely and accurate resolution.
  • Maintain detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
  • 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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