Insurance Claim Processor

2 days ago


Gandhinagar, Gujarat, India beBeeClaim Full time ₹ 9,00,000 - ₹ 12,00,000
Job Title: Claims Specialist

About this role:

The primary objective of a claims specialist is to efficiently and accurately process and manage cashless insurance claims, ensuring timely closure for policyholders and seamless coordination with insurance providers.

This role involves verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring that claims are processed accurately and efficiently. The specialist will also communicate with employees or dependants to provide updates on the status of their claims and address any questions or concerns.

Key Responsibilities:

  1. Manage end-to-end cashless claims of employees, verifying policy coverage, reviewing medical records, and coordinating with insurers.
  2. Verify Policy Coverage: Review and verify policy details to ensure that the claim is eligible for cashless processing according to the terms and conditions of the insurance policy.
  3. Provide Customer Service: Respond to inquiries from employees and stakeholders regarding claim status and related queries.
  4. Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details.
  5. Resolve Issues: Investigate and resolve discrepancies, errors, or issues that may arise during claim processing.
  6. Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions.
  7. Meet 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:

  1. At least 2 years of experience in customer-facing roles
  2. Past Experience in voice profile would be an added advantage
  3. Experience in cashless/ TPA


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