
Claims Executive
2 days ago
Vidal is hiring for Claims-Executive
Work Location: Gurgaon
**Work from Office only**
**Key Responsibilities**
**Claim Review & Validation**
- Examine submitted claims for completeness and accuracy
- Verify policy coverage and eligibility
- Identify discrepancies or missing documentation
**Claims Processing**
- Enter and adjudicate claims in the system (cashless & reimbursement)
- Calculate payable amounts as per policy terms
- Ensure timely processing within defined SLAs
**Stakeholder Communication**
- Liaise with policyholders, hospitals, and insurers for claim clarifications
- Respond to queries and provide claim status updates
- Coordinate with Preauth and Customer Care teams
**Documentation & Compliance**
- Maintain detailed records of claims and actions taken
- Ensure adherence to IRDAI guidelines and internal SOPs
- Flag potential fraud or irregularities for investigation
**Reporting & Analysis**
- Generate daily/weekly/monthly claim reports
- Track claim trends and highlight recurring issues
- Support audits and internal reviews with accurate data
**Skills & Competencies**
- Strong attention to detail and data accuracy
- Familiarity with medical terminology, ICD/CPT codes
- Proficiency in claims software (Portal)
- Effective communication and problem-solving skills
- Ability to manage sensitive information with discretion
**Experience Required**
- **2-3 years** of experience in **claims processing** within the **TPA or Health Insurance** domain
- Exposure to group health policies and coordination with hospitals or corporate clients is preferred
**Job Types**: Full-time, Permanent
Pay: ₹20,000.00 - ₹25,000.00 per month
**Experience**:
- total work: 1 year (preferred)
Work Location: In person
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