Cashless Claims Processor
3 days ago
This is a key role within the organization responsible for processing and managing cashless insurance claims efficiently and accurately. The Claims Specialist will ensure timely closure to policyholders and seamless coordination with insurance providers.
Job Purpose:The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently.
Principal Accountabilities:- Act as a Claims buddy - Manage end-to-end cashless claims of employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently.
- Verify Policy Coverage: 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.
- Provide Customer Service: Respond to inquiries from employees, and other stakeholders regarding claim status, and any other related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information, clarify details, (whenever required).
- Resolve Issues: Investigate and resolve any discrepancies, errors, or issues that may arise during the processing of cashless claims to ensure timely and accurate resolution.
- Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
- Adhere to Service Level Agreements: Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
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Claims Specialist
3 days ago
India Plum Full timeAbout Job:- Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers. The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes...
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Automated Claims Processor
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Medical Advisor
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Medical Advisor
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