Healthcare Claims Manager

6 days ago

Bengaluru, Karnataka, India beBeeClaims Full time ₹ 15,00,000 - ₹ 20,00,000
Claims Specialist

About our company

We are a leading innovator in the education ecosystem, transforming the 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 families.

We partner with 5,000+ top educational institutions across the country, making us a trusted name in education-focused financial services.

Backed by respected investors and entrepreneurs, we are entering an exciting new phase.

This is a high-impact opportunity to be at the forefront of building a new vertical from the ground up.

Role Overview:

The Claims Specialist will oversee and manage the end-to-end claims process for 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.

The ideal candidate will have a strong background in health insurance claims management, excellent problem-solving skills, and the ability to deliver a seamless customer experience.

This is a full-time, on-site role based in Mumbai with immediate joining.

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 IRDAI 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:
  • Education: 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: IRDAI Health Insurance certification or equivalent 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.

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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