
Senior Health Insurance Claims Manager
24 hours ago
As a dedicated professional, you will play a crucial role in the success of our health insurance claims management team.
The ideal candidate will possess 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, third-party administrators (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:
- Bachelor's degree in Business, Finance, Insurance, or related field.
Preferred Qualifications:
- 3–6 years of proven experience in health insurance claims management or related roles.
- IRDAI Health Insurance certification or equivalent preferred.
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:
- Customer-first mindset with empathy and professionalism.
- Ability to work under pressure and meet strict deadlines.
- Strong organizational skills and accountability.
Why Join Us?
Here's why we're different:
- Guidance, not pressure—helping families make confident decisions.
- Be part of creating a vertical from scratch at a fast-growing fintech.
- IRDAI compliance, customer-first service, and honesty are non-negotiable.
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