 
						Customer Relationship Manager
11 hours ago
Job Summary:
We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service. The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy, regulatory compliance, and empathetic customer support.
Key Responsibilities:
- Medical Review & Claims Adjudication: 
- Assess and validate medical claims based on clinical documentation and policy coverage. 
- Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.
- Coordinate with internal medical teams to ensure accuracy in claims decision-making. 
- Customer Interaction & Support: 
- Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner. 
- Handle escalated or complex customer service issues involving medical claims.
- Offer support and guidance on claim submission processes and documentation requirements. 
- Compliance & Documentation: 
- Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines. 
- Maintain accurate records of claim assessments, approvals, denials, and communications.
Required Qualifications:
- Education: 
- MBBS, BDS, BHMS, BAMS, or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus. 
- Experience: 
- Minimum 25 years of experience in health insurance, especially in claims processing, medical underwriting, or TPA operations. 
- Proven track record of customer service experience in a healthcare or insurance setting. 
- Skills: 
- Strong clinical judgment and attention to detail. 
- Excellent communication and interpersonal skills.
- Proficient in claims management systems and MS Office.
- Ability to handle sensitive medical information with confidentiality and professionalism.
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