
Claims Management Professional
2 days ago
Job Title:
Claims Manager
About the Job:
A Claims Manager is responsible for overseeing the efficient and accurate processing of cashless insurance claims. This includes verifying policy coverage, reviewing medical records, and coordinating with Insurers to ensure timely closure to policyholders.
The primary purpose of a Claims Manager is to process and manage cashless claims for employees. This involves verifying policy details, reviewing medical records, and ensuring that claims are processed accurately and efficiently.
Key Responsibilities:
- Manage end-to-end cashless claims of employees, including verifying policy coverage and reviewing medical records.
- 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 regarding claim status and any other related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information or clarify details whenever required.
- Resolve Issues: Investigate and resolve any 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.
- Achieve NPS of 92+ in the cashless claims handled.
Interactions:
- Internal Clients: Endorsement team, Onboarding team, Products & engineering, Claims teams, Support Inbound.
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