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
Interested candidate can connect 9971006988
Job Types: Full-time, Permanent
Pay: ₹22,000.00 - ₹25,000.00 per month
Experience:
- total work: 1 year (Preferred)
Work Location: In person