Insurance Claims Manager

11 hours ago

Bhavnagar, Gujarat, India beBeeInsurance Full time ₹ 60,00,000 - ₹ 80,00,000

About Job:

This role is responsible for overseeing the management of cashless insurance claims, ensuring timely and accurate processing to policyholders.

The Insurance Claims Manager will be in charge of verifying policy coverage, reviewing medical records, coordinating with Insurers, and maintaining accurate records of claim-related activities. This specialist may also be responsible for communicating with employees or dependants regarding claim status and any questions or concerns they may have.

Key Responsibilities:

  1. Manage end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and ensuring accurate and efficient processing.
  2. Verify Policy Coverage: Review and verify policy details to ensure eligibility for cashless processing according to the terms and conditions of the insurance policy.
  3. Provide Customer Service: Respond to inquiries from employees and other stakeholders regarding claim status and related queries.
  4. Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details as needed.
  5. Resolve Issues: Investigate and resolve discrepancies, errors, or issues arising during the processing of cashless claims to ensure timely and accurate resolution.
  6. Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
  7. 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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