Senior Medical Claims Professional

14 hours ago


Pune, Maharashtra, India beBeeClaims Full time ₹ 1,04,000 - ₹ 1,30,878

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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