
Cashless Insurance Claims Manager
1 day ago
Role Overview:
The Claims Management Specialist is responsible for the efficient and accurate processing of cashless insurance claims, ensuring timely closure to policyholders and seamless coordination with insurance providers.
This role involves verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently. The Claims Management Specialist will also communicate with employees or dependants to provide updates on the status of their claims and address any questions or concerns.
Key Responsibilities:
- Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate and efficient processing.
- Verify policy details to ensure claim eligibility for cashless processing according to insurance policy terms and conditions.
- Provide customer service by responding to inquiries from employees and other stakeholders regarding claim status and related queries.
- Coordinate with healthcare providers to obtain additional information and clarify details as needed.
- Investigate and resolve discrepancies, errors, or issues arising during claim processing to ensure timely and accurate resolution.
- Maintain detailed and accurate records of claim-related activities, communications, and transactions for documentation and audit purposes.
- Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
- Achieve an NPS of 92+ in cashless claims handled.
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