
Financial Claim Services Specialist
9 hours ago
About the Job:
A Claims Management Specialist plays a pivotal role in ensuring the seamless and timely processing of cashless insurance claims.
The job purpose is to facilitate the efficient and accurate resolution of cashless claims, verifying policy coverage, reviewing medical records, and coordinating with Insurers.
Key Responsibilities:
- End-to-end cashless claim management, including verification of policy coverage, review of medical records, and coordination with Insurers.
- Policy Coverage Verification: Ensure that claims are eligible for cashless processing according to the terms and conditions of the insurance policy.
- Customer Service: Respond to inquiries from employees and stakeholders regarding claim status and any related queries.
- Coordination with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details when required.
- Error Resolution: Investigate and resolve discrepancies, errors, or issues that may arise during the processing of cashless claims.
- Record Maintenance: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
- Service Level Agreement Adherence: Meet 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:
- At least 2 years of experience in customer-facing roles
- Past Experience in voice profile would be an added advantage
- Experience in cashless/TPA
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