Healthcare Claims Expert

2 days ago

Aurangabad, Maharashtra, India beBeeClaims Full time ₹ 9,00,000 - ₹ 12,00,000

Transform the Healthcare Landscape as a Claims Manager

An exciting opportunity awaits an experienced professional to oversee and manage the end-to-end claims process for customers.

  • Claims Lifecycle Management: Ensure seamless verification, documentation, submission, follow-up, and settlement of health insurance claims.

  • Customer Engagement: Assist clients through the claims journey, guaranteeing accurate and complete forms, and prompt submissions.

  • Insurance Partnerships: Collaborate with insurers, third-party administrators, and healthcare providers to expedite claim resolutions.

  • Issue Resolution: Investigate discrepancies, clarify benefits, and negotiate fair outcomes for clients, resolving escalations, rejections, and disputes.

  • Compliance & Accuracy: Adhere to IRDAI guidelines, insurer protocols, and internal compliance standards to ensure claims handling meets industry benchmarks.

  • Performance Tracking: Monitor claim turnaround times, analyze claim outcomes, and prepare regular reports on performance and trends.

  • Process Enhancement: Identify inefficiencies in claims workflows and recommend process improvements to enhance speed, accuracy, and customer satisfaction.

Requirements:

  • Education: Bachelor's degree in Business, Finance, Insurance, or a related field.

  • Experience: 3–6 years of proven experience in health insurance claims management or a related role.

  • Certifications: IRDAI Health Insurance certification or equivalent preferred.

Skills & Attributes:

  • 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.

  • Proficiency in MS Office and claims management/CRM systems.

Why This Role is Unique:

  • Customer-centric approach with empathy and professionalism.

  • Ability to work under pressure and meet strict deadlines.

  • Strong organizational skills and accountability.

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