
Health Insurance Claims Specialist
7 days ago
We are seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers. In this role, you will serve as the primary liaison between clients, insurers, third-party administrators (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-focused 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.
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.
SkillsStrong 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.
Proficiency in MS Office and claims management/CRM systems.
Why Choose Us?Our organization provides guidance, not pressure—helping families make confident decisions.
We offer a unique opportunity to build something new at a fast-growing fintech.
We prioritize trust, transparency, and honesty in all aspects of our business.
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