Claims Operations Specialist
8 hours ago
About Us:
We're a leading FinTech innovator in the education ecosystem, transforming the education industry through our cutting-edge financial solutions. Our flagship offering—monthly EMI solutions for school and college fee payments—makes education more accessible, affordable, and rewarding for millions of families.
Our unique approach to education financing has earned us a trusted name among top educational institutions across the country. We partner with over 5,000+ esteemed educational institutions, making us a household name in education-focused financial services.
As part of our strategic expansion, we've launched a new insurance vertical focused on providing customized life and health insurance products to families within our network and beyond. This is a high-impact opportunity to be at the forefront of building this vertical from scratch.
Job Overview
We're seeking an experienced Health Insurance Claims Manager to oversee and manage the end-to-end claims process for our customers. In this role, you will serve as the primary liaison between clients, insurers, TPAs, and healthcare providers to ensure claims are handled smoothly, accurately, and on time.
The ideal candidate will have a strong background in health insurance claims management, excellent problem-solving skills, and the ability to deliver a seamless, customer-focused experience. This is a full-time, on-site role based in Mumbai with immediate joining.
Key Responsibilities:
- Manage the complete lifecycle of health insurance claims, including verification, documentation, submission, follow-up, and settlement.
- Assist and guide customers through the claims journey, ensuring forms and documents are accurate, complete, and submitted promptly.
- Collaborate with insurers, third-party administrators (TPAs), and hospitals to ensure quick and accurate claim resolutions.
- Handle escalations, rejections, and disputes by investigating discrepancies, clarifying benefits, and negotiating fair outcomes for clients.
- Ensure claims handling aligns with regulatory guidelines, insurer protocols, and internal compliance standards.
- Track claim turnaround times, analyze claim outcomes, and prepare periodic reports on performance and trends.
- Identify inefficiencies in claims workflows and recommend process enhancements to improve speed, accuracy, and customer satisfaction.
Requirements:
A bachelor's degree in Business, Finance, or a related field is required. A minimum of 3–6 years of proven experience in health insurance claims management or related roles is preferred. An IRDAI Health Insurance certification or equivalent is also desirable.
Desirable 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:
- A customer-first mindset with empathy and professionalism.
- The ability to work under pressure and meet strict deadlines.
- Strong organizational skills and accountability.
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