Career Opportunities: Claims Manager
16 hours ago
About the Role:
As a Claims Manager, you will be responsible for efficiently and accurately processing cashless insurance claims to ensure timely closure to policyholders and seamless coordination with insurance providers.
This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently. The successful candidate 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 Coverage: Review and verify policy details to ensure claim eligibility according to insurance policy terms and conditions.
- Provide Customer Service: Respond to inquiries from employees and other stakeholders regarding claim status and related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details as needed.
- Resolve Issues: Investigate and resolve discrepancies, errors, or issues arising during claim processing to ensure timely and accurate resolution.
- Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
- Meet 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:
- At least 2 years of experience in customer-facing roles
- Past Experience in voice profile is an added advantage
- Experience in cashless/ TPA
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