
Senior Medical Claims Professional
14 hours ago
We are currently seeking a Claims Specialist with a strong background in medical and health insurance, particularly in corporate group medical policies.
Key Responsibilities:
- The ideal candidate will handle end-to-end processing of reimbursement claims for corporate group medical policies.
- They will provide excellent customer service by addressing claims-related queries via multiple channels.
- A thorough analysis of medical documentation, policy terms, and conditions will be required to ensure accurate claim assessment and processing.
- Liaising with internal teams, insurers, third-party administrators (TPAs), and hospitals will be necessary to ensure seamless claims settlement and timely resolutions.
- Effective management of claims escalations, ensuring prompt resolution while maintaining a customer-centric approach, is also expected.
Required Skills:
- In-depth knowledge of corporate group medical insurance policies and claims processing.
- Ability to understand medical terminology, treatment procedures, and health-related documentation.
- Proficiency in customer support and claims management tools.
- Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively.
- Attention to detail to ensure accuracy in claim processing and documentation review.
Qualifications:
- Bachelor's degree in healthcare, insurance, or a related field is preferred.
- 2-4 years of experience in claims processing or CRM roles, preferably within corporate group medical policies.
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