
Cashless Insurance Claim Specialist
24 hours ago
Claims Management Professional
Job Description:
This role is responsible for efficiently and accurately processing and managing cashless insurance claims, ensuring timely closure to policyholders and seamless coordination with insurance providers.
The key objective of this position is to facilitate the smooth and timely processing of cashless claims, enabling employees to receive the benefits they are entitled to.
Responsibilities include:
- Manage end-to-end cashless claims for employees, verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring accurate and efficient processing.
- Verify Policy Coverage: Review and verify policy details to ensure claim eligibility according to insurance policy terms and conditions.
- Provide Customer Service: Respond to inquiries from employees and stakeholders regarding claim status and related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information, clarify details, and resolve issues.
- 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.
Interactions:
Internal Clients: Endorsement team, Onboarding team, Products & engineering, Claims teams, Support Inbound, Account Management
External Clients: Insurers, Client HR's, Hospitals
Requirements:
At least 2 years of experience in customer-facing roles
Past Experience in voice profile would be an added advantage
Experience in cashless/ TPA
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