Insurance Claims Processor

2 weeks ago

Aurangabad, Maharashtra, India beBeeClaims Full time ₹ 80,00,000 - ₹ 1,20,00,000
About the Role

The Claims Management Specialist plays a vital role in streamlining cashless insurance claims processing, ensuring efficient and accurate handling for timely closure to policyholders and seamless coordination with insurance providers.

This entails verifying policy coverage, reviewing medical records, coordinating with Insurers, and guaranteeing that claims are processed accurately and efficiently. The processor may also be responsible for communicating with employees or dependants to provide updates on the status of their claims and address any questions or concerns.

Key Responsibilities:

  • Manage end-to-end cashless claims of employees by verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate and efficient processing.
  • Verify policy details to ensure claim eligibility according to insurance policy terms and conditions.
  • Provide customer service by responding to inquiries from employees and other stakeholders regarding claim status and related queries.
  • Coordinate with healthcare providers to obtain additional information and clarify details.
  • Investigate and resolve discrepancies, errors, or issues that arise during claim processing to ensure timely and accurate resolution.
  • Maintain detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
  • Adhere to established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.

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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