Health Claims Processor

2 weeks ago

HITEC City Hyderabad Telangana, India HealthPay Full time

Health Claims Processor

Location: Hyderabad / Remote

Employment Type: Full-time / Contract

Experience Required: 1-3 years in health insurance claim processing or TPA operations

About HealthPay

HealthPay is a pioneering AI-driven platform transforming the health insurance claim process. Our software automates claim adjudication with approximately great accuracy. We are seeking skilled professionals to process health claims, verify automated decisions, and ensure every claim meets the highest standards of accuracy and compliance.

Role Summary

Key Responsibilities
- **Process health insurance claims** using the HealthPay platform and closely review AI-generated outcomes.
- **Crosscheck all details** in each claim, including deductions, coverage decisions, and compliance with policy guidelines.
- **Compare claim outcomes** against hospital documents (e.g., itemized bills, discharge summaries, policy documents).
- **Document corrections** and maintain clear, auditable records for every claim processed.
- **Communicate patterns of common errors** to the engineering team to support ongoing product improvement.
- **Meet performance benchmarks** on accuracy, turnaround time, and compliance standards.
- **Liaise with internal teams** to resolve complex issues or escalate claims requiring special handling.

**Requirements**:

- 1-3 years of health insurance claim processing experience (TPA or hospital background preferred).
- Strong understanding of medical and non-medical claim components, policy documentation, and insurance rules.
- Proven ability to review structured data and supporting documents (PDFs, Excel).
- High attention to detail and commitment to error-free claim handling.
- Good documentation and record-keeping skills.
- Effective communication abilities for internal collaboration.
- **Bachelor’s degree in Life Sciences, Pharmacy, Nursing, Healthcare Administration, or similar (preferred but not mandatory).**:

- Comfort using digital tools and learning new software platforms.

What We Offer
- Opportunity to work with **leading-edge AI technology** in health insurance.
- Fast-paced, growth-focused environment.
- Hybrid/remote work flexibility.
- Continuous learning and exposure to both healthtech and process automation.

Join Us

If you have a background in health claims processing and are ready to partner with innovative technology to deliver seamless insurance experiences, we invite you to apply. At HealthPay, you’ll play a crucial role in ensuring every claim is fair, timely, and accurate.

Pay: ₹200,000.00 - ₹400,000.00 per year

**Benefits**:

- Health insurance
- Provident Fund

Schedule:

- Monday to Friday
- Weekend availability

Supplemental Pay:

- Commission pay
- Performance bonus

Application Question(s):

- How many years have you worked in health insurance claim processing or TPA adjudication workflows?
- Can you explain what non-medical deductions and non-payables are in the context of health insurance?
- What steps do you take to ensure the accuracy and completeness of your work?
- How do you document your claim review process and communicate feedback to technical or operations teams?
- Describe a situation where you had to meet strict turnaround times (SLAs) while ensuring high quality.

Work Location: In person

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