Mediclaim Executive

19 hours ago

Pune Maharashtra, India RISING MEDICARE HOSPITAL Full time

Address: _**Survey No 4/1, Mundhwa - Kharadi Road,**_
- **behind Radisson Blu, Pandhari Nagar,**_
- **Kharadi, Pune, Maharashtra 411014**_

**Job Summary**:
The Mediclaim Executive is responsible for handling medical insurance claims, processing reimbursements, coordinating with insurance companies, and ensuring smooth claim settlements for patients. The role requires attention to detail, knowledge of insurance policies, and excellent communication skills.

**Key Responsibilities**:

- Process and verify medical insurance claims for reimbursement and cashless services.
- Coordinate with hospitals, insurance providers, and TPAs (Third-Party Administrators) to facilitate smooth claim processing.
- Review and validate claim documents, ensuring accuracy and completeness.
- Follow up on pending claims, rejections, and discrepancies with insurers.
- Assist customers in understanding their health insurance policies and claim procedures.
- Maintain records of claims, approvals, and denials for reporting and audit purposes.
- Ensure compliance with regulatory guidelines and company policies regarding insurance claims.
- Address queries from patients, insurers, and hospital staff regarding claims and coverage.
- Identify fraudulent claims and report suspicious activities.
- Work on claim settlements, escalations, and appeals when required.

**Required Skills & Qualifications**:

- Bachelor's degree in any field
- 1 to 5 years of experience in medical insurance claims processing, TPA, or hospital billing.
- Strong knowledge of health insurance policies, claim procedures, and IRDA regulations.
- Proficiency in MS Office (Excel, Word) and hospital management systems.
- Excellent communication and interpersonal skills.
- Strong problem-solving ability and attention to detail.
- Ability to handle multiple tasks and meet deadlines in a fast-paced environment.

**Preferred Qualifications**:

- Experience in working with hospital billing departments or insurance companies.
- Familiarity with medical terminologies and coding (ICD, CPT).
- Knowledge of e-claims submission portals and insurance software.

**Job Types**: Full-time, Permanent

Pay: ₹20,000.00 - ₹25,000.00 per month

**Benefits**:

- Provident Fund

Schedule:

- Day shift

Supplemental Pay:

- Performance bonus

Work Location: In person

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