Claim Processor

2 weeks ago

Gurugram Hyderabad Mumbai, India Career Shaper Full time ₹ 6,00,000 - ₹ 12,00,000 per year

OPEN FOR FRESHERS BHMS AND BMS DOCTORS

Knowledge of Claims processes: Indemnity (Cashless, Reimbursement), Fixed Benefit Products

  • Understanding of Claims systems (process flow & System fields) Health, PA & Travel
  • Experience in measurement of performance (TAT, accuracy in claims adjudication)
  • Expectations management of the Claims team
  • TAT & expectations management for specialized business handling.
  • Ensure uniformity in quality & maintain TATs of Claims decisions
  • Create & maintain standards/protocols for Claims team
  • Audit claims decisions in adherence & compliance with the Claims guidelines, uniformity in decisions, and approval authority limits (In house and TPA claims)
  • Periodic portfolio analysis: profitability (loss ratio / combined ratio), analyze frequency and severity, medical inflation
  • Maintain a consistent service delivery to ensure client retention and satisfaction
  • Identify risks to the company and escalate accordingly
  • Execution of processes and projects operations, to be in line with defined standards
  • Inputs for refinement and development of claims guidelines, policies, and procedures.

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