Insurance Claim Resolution Manager

1 week ago


Tirupati, Andhra Pradesh, India beBeeCustomerService Full time ₹ 8,00,000 - ₹ 12,00,000
Claims Management Specialist

About the Role:

The Claims Management Specialist is responsible for efficiently and accurately processing cashless insurance claims, ensuring timely closure to policyholders and seamless coordination with insurance providers.

This position involves verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently. The Claims Management Specialist may also be responsible for communicating 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, including verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate and efficient processing.
  2. Verify Policy Coverage: Review and verify policy details to ensure claim eligibility according to insurance policy terms and conditions.
  3. Provide Customer Service: Respond to inquiries from employees and other stakeholders regarding claim status and related queries.
  4. Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details as required.
  5. Resolve Issues: Investigate and resolve discrepancies, errors, or issues that arise during cashless claim processing to ensure timely and accurate resolution.
  6. Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
  7. Adhere to 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 HRs, 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

Benefits: This role offers a challenging and rewarding work environment with opportunities for professional growth and development. We value our employees' contributions and offer competitive compensation and benefits packages.



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