Manager- Medical Claims

3 days ago

Gurgaon, India Care Insurance Full time

Job Description : Reimbursement & Cashless Claims Specialist

Job Summary: The Reimbursement & Cashless Claims Specialist is responsible for managing and processing reimbursement claims accurately and efficiently. This role involves verifying the completeness and accuracy of claims, liaising with internal departments and external partners, and ensuring compliance with company policies and regulatory requirements. The specialist will handle claims inquiries, resolve discrepancies, and maintain detailed records to support the financial integrity of the organization.

Key Responsibilities:

  • Claims Processing:
  • Review and process reimbursement claims.
  • Ensure all required documentation is provided and accurately completed.
  • Enter claim information into the financial system for processing and payment.

  • Verification and Compliance:
  • Verify the authenticity and accuracy of submitted claims.
  • Ensure claims comply with company policies, procedures, and regulatory requirements.
  • Identify and investigate discrepancies or potential fraudulent claims.

  • Customer Service:
  • Respond to inquiries from employees, clients, and other stakeholders regarding reimbursement policies and claim status.

Skills:

  • Strong analytical and problem-solving skills.
  • Excellent attention to detail and organizational abilities.
  • Effective communication and interpersonal skills.

Preferred Qualifications:

Graduate in BAMS, BUMS, BPT ,BHMS and BDS.

Minimum 1 year of experience of claims processing is required.

Location - Gurugram. (Work from Office)

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