Cashless Claims Specialist

2 days ago

Madurai, Tamil Nadu, India beBeeClaimsProcessor Full time ₹ 8,00,000 - ₹ 10,00,000

Job Purpose:

The Claims Processor is responsible for processing and managing cashless insurance claims efficiently and accurately, 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 Processor will also communicate with employees or dependants to provide updates on the status of their claims and address any questions or concerns.

Key Responsibilities:

  • Act as a Claims processor - 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 that the claim is eligible for cashless processing according to the terms and conditions of the insurance policy.
  • 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, clarify details, and resolve issues.
  • Resolve Issues: Investigate and resolve discrepancies, errors, or issues that may arise during the processing of cashless claims 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.
  • Adhere to 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 HR's
  • Hospitals

Requirements:

  1. At least 2 years of experience in customer-facing roles
  2. Past Experience in voice profile would be an added advantage
  3. Experience in cashless/ TPA

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