Claims Processor

**Job Title**:Sr. Executive - Insurance Adjudication

**Function**:Insurance Adjudication

**Job Type**:Full Time Job

**Reports To**:Assistant Manager - Insurance Adjudication

**Location**:Bengaluru (Kanakapura Main Road, JP Nagar 9th phase )

Medical Insurance Adjudication Department at **We Assist** has an important role of managing the relationship with Insurance Companies, Hospital Relations, Billing Related Queries, Client
Relationship Management to ensure that the **We Assist **continues to be a competitive service provider in the Insure Tech, Reimbursement Claim Settlement and the related industry. With ambitious growth plans in mind, **We Assist** is looking to offer cutting edge solutions to both patients and the partner hospitals by leveraging technology and with unique product offerings.

**Job Duties & Responsibilities**
- Play as an intermediate role Between the Insurance co. and Hospital and We Assist

Team.
- Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive.
- Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy.
- Evaluating of claims and posting the remarks in what’s app group and updating in CRM.
- Monitoring billing as per the Tariff.
- Managing claims escalations form hospitals.
- Responsible to handling queries raised by insurance company / TPAs
- Provide technical assistance and to conduct training sessions for new processors on various health insurance policies.
- Evaluate complete claim documents before submission.
- Coordinate with Internal team to understand patient enquires.
- Helping team to understand the Non-medical Items.
- To create awareness about reimbursement claims. (Pre, Post & Hospitalization) and communicating the important updates to the Claims Assistance and Finance

Department
- Be available at the office for supporting onsite staff on all six days in a week b/w 9.30am to 7.00pm
- Efficiently and effectively handle grievance / issue raised by hospital staff & patients, escalate issue to the team leader, Manager - Insurance Adjudication and Business Head as necessary.
- Follow-up on the updates to be given to the clients / onsite team of Claims Assistance

Department

**Qualifications & Skills.**
- B-Pharma / D-Pharma
- 1 - 2 years of relevant experience
- Should have good analytical skills
- Excellent interpersonal & communication skills

Experience.
- 1 -2 years of experience in TPA or Insurance claims or similar field

Additional Skills.
- Strong verbal skills - Fluency in English & Kannada.
- Strong problem-solving skills and enthusiasm for new tasks and challenges
- Relationship building skills.
- Ability to multitask and prioritize, with a strong work ethic and attention to detail
- Ability to operate with a high level of confidentiality and professionalism
- Willingness to accept a high degree of uncertainty, jump in and help wherever needed, get hands dirty, and wear multiple hats on a fast-moving team.
- Should be able to manage the task assigned, while managing the tasks of the team/ team members that are assigned
- Should have an ability to manage and maintain smooth relationship with cross functional department such as Finance, Claims Assistance, Back-Office and Marketing

Team

About Us

We Assist is a disruptor in the field of InsureTech, Reimbursement Claims, Partner for many renowned Corporate Hospital Chains

We Assist offers one of its kind services that is designed to assist Health Insurance customers for a hassle-free Reimbursement Claim Experience. In the last 5 years we have solved thousands of reimbursement cases and boast about many happy customers. While the hospitals and family members of patients are focusing on the well-being of the patients, we take care of the cumbersome logistics and the laborious claim process on client’s behalf.

Our 3 decades of experience and the legacy in the insurance industry via our parent company
Karthika Insurance makes it easier to interact with the key stake holders and to get the job done on behalf of Partner Hospitals and Patients. We are based out of Bangalore, Karnataka and soon spreading our wings across India and are looking to grow faster.

**Job Types**: Full-time, Regular / Permanent, Fresher

**Salary**: Up to ₹25,000.00 per month

**Benefits**:

- Health insurance
- Paid sick time
- Provident Fund

Schedule:

- Day shift

Supplemental pay types:

- Performance bonus

Ability to commute/relocate:

- Bengaluru, Karnataka: Reliably commute or planning to relocate before starting work (required)

**Experience**:

- total work (preferred)

**Speak with the employer**
+91 08660393081
- Health insurance