Health Insurance Claims Professional

1 week ago

Hyderabad, Telangana, India beBeeClaim Full time ₹ 7,80,000 - ₹ 12,11,000

About Us

We're transforming the education industry through cutting-edge financial solutions. Our flagship offering—monthly EMI solutions for school and college fee payments—makes education more accessible, affordable, and rewarding for millions of Indian families.

As part of our strategic expansion, we've launched a new insurance vertical focused on providing customised life and health insurance products to families within our network and beyond. This is a high-impact opportunity to be at the forefront of building this vertical from the ground up.

Job Summary:

We're seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers. In this role, you will serve as the primary liaison between clients, insurers, TPAs, and healthcare providers to ensure claims are handled smoothly, accurately, and on time.

Key Responsibilities:

  • 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.

Requirements:

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

Experience:

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

Certifications:

  • Relevant certifications in health insurance preferred.

Skills:

  • 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.

Attributes:

  • 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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