
Senior Health Insurance Claims Manager Position
2 days ago
Health Insurance Claims Manager
About This Role:This is a career-defining opportunity for an experienced Health Insurance Claims Manager to join our team and take on a pivotal role in the end-to-end claims process.
You will serve as the primary liaison between clients, insurers, third-party administrators, and healthcare providers to ensure 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, 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 regulatory 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, 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.
Attributes
- Customer-first mindset with empathy and professionalism.
- Ability to work under pressure and meet strict deadlines.
- Strong organizational skills and accountability.
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