Senior Health Claims Specialist

24 hours ago

Rajahmundry, Andhra Pradesh, India beBeeHealth Full time ₹ 9,00,000 - ₹ 12,00,000

Unlock a Career Opportunity

A Health Insurance Claims Manager is needed to oversee and manage the end-to-end claims process for customers. This role requires serving as the primary liaison between clients, insurers, third-party administrators (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.

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, 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 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.

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:

  • Regulatory certification in health insurance 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.

Why Apply?

  • Chance to Build Something New: Be part of creating a vertical from scratch at a fast-growing organization.
  • Trust & Transparency: Compliance with regulations, customer-first service, and honesty are non-negotiable.

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