Health Claim Executive

1 day ago

Anand, Gujarat, India P & C INSURANCE SERVICES Full time ₹ 12,000 - ₹ 1,50,000 per year

Job Summary:

We are looking for a dedicated and detail-oriented Health Claim Executive to manage and process health insurance claims efficiently. The ideal candidate should have a good understanding of health insurance policies, claim procedures, and relevant documentation. This role is crucial in ensuring timely and accurate settlement of claims while providing excellent customer service.

Key Responsibilities:

  • Scrutinize and verify claim documents submitted by clients/hospitals.
  • Coordinate with hospitals, TPAs, and policyholders for claim-related queries.
  • Evaluate claims based on policy terms, conditions, and exclusions.
  • Process cashless and reimbursement claims in a timely manner.
  • Ensure all claims are processed as per company guidelines and within the TAT (Turnaround Time).
  • Maintain accurate claim records and update internal systems.
  • Follow up with internal teams and external stakeholders for pending documentation.
  • Identify fraudulent or suspicious claims and report accordingly.
  • Provide claim status updates and support to customers.
  • Assist in claim audits and MIS reporting.

Required Qualifications & Skills:

  • Graduate in any discipline (B.Com, B.Sc., BBA preferred).
  • 1–3 years of experience in health insurance claim processing or related field.
  • Knowledge of health insurance products and IRDA regulations.
  • Familiarity with cashless and reimbursement claim procedures.
  • Proficiency in MS Office and claim management software.
  • Strong communication (verbal and written) and interpersonal skills.
  • Ability to handle pressure and multitask.
  • Customer-focused approach with problem-solving abilities.

Job Type: Full-time

Pay: ₹12, ₹15,000.00 per month

Work Location: In person

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