
Chief Health Insurance Claims Specialist
9 hours ago
We are seeking a highly skilled and experienced Health Insurance Claims Manager to join our team. In this role, you will oversee the end-to-end claims process for our customers, ensuring that all claims are handled smoothly, accurately, and on time.
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.
- Proficiency in MS Office and claims management/CRM systems.
- Customer-Focused Service: We prioritize our customers' needs and provide personalized support throughout the claims process.
- Opportunity for Growth: Join a dynamic team and contribute to the growth and development of our health insurance business.
- Professional Environment: Our work environment is collaborative, supportive, and committed to excellence.
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