Sr. Associate OPD claim handler

2 days ago

Bengaluru, Karnataka, India ACKO Full time ₹ 4,00,000 - ₹ 6,00,000 per year
About Job

Claim handler working on OPD (Outpatient Department) claims,

Skills & Qualification

  • Medical background

  • Healthcare expertise

  •  Strong analytical and attention-to-detail skills

    Ability to identify policy compliance issues or mismatched documentation

    Clear and professional email communication with customers and internal teams

    Ownership of cases until closure (especially when follow-up documents are pending)

Responsibilities

  • ·       Understanding of OPD coverage under different policy types (corporate, retail, etc.).

    ·       Ability to interpret policy terms, sub-limits, and exclusions related to OPD.

    ·       Familiarity with standard treatment and diagnostic codes (ICD, CPT, or similar).

    ·       Knowledge of claim processing workflows — from registration to adjudication and payment.

    ·       Awareness of fraud indicators (e.g., repeated consultations, manipulated invoices, or fabricated prescriptions).

  • Proficiency in the claim processing system

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