
Insurance Claim Handler
1 week ago
About this role:
As a Claims Management Specialist, you will be responsible for processing and managing cashless insurance claims efficiently and accurately.
This includes verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring that claims are processed accurately and efficiently.
As a Claims Management Specialist, you will facilitate the smooth and timely processing of cashless claims to ensure that employees receive the benefits they are entitled to.
Key responsibilities include:
- Managing end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and coordinating with insurers.
- Verifying policy details to ensure claim eligibility according to terms and conditions of the insurance policy.
- Providing customer service to employees and other stakeholders regarding claim status and related queries.
- Communicating with healthcare providers and hospitals to obtain additional information or clarify details.
- Resolving any discrepancies, errors, or issues that may arise during claim processing.
- Maintaining accurate records of all claim-related activities, communications, and transactions.
- Meeting or exceeding established service level agreements and performance metrics related to claim processing and customer satisfaction.
Interactions with internal and external clients include:
- Endorsement team
- Onboarding team
- Products & engineering
- Claims teams
- Support Inbound
- Account Management
- Insurers
- Client HR's
- Hospitals
To excel in this role, candidates should possess:
- At least 2 years of experience in customer-facing roles.
- Past experience in voice profiles is an added advantage.
- Experience in cashless/ TPA.
Processing cashless claims efficiently and accurately, while providing excellent customer service to employees and other stakeholders, can bring numerous benefits. These include:
- Timely resolution of claims, ensuring employees receive the benefits they are entitled to.
- Improved employee satisfaction and retention rates.
- Enhanced reputation and credibility within the industry.
- Increased efficiency and productivity within the organization.
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