Health Claims Processor
Location: Hyderabad / Remote
Employment Type: Full-time / Contract
Experience Required: 1–3 years in health insurance claim processing or TPA operations
About HealthPay
HealthPay is a pioneering AI-driven platform transforming the health insurance claim process. Our software automates claim adjudication with approximately great accuracy. We are seeking skilled professionals to process health claims, verify automated decisions, and ensure every claim meets the highest standards of accuracy and compliance.
Role Summary
As a Health Claims Processor, you will leverage HealthPay’s software to handle end-to-end health insurance claims. While our application automates most steps, your responsibility is to review each AI-processed claim, identify and correct any errors, and guarantee precise, compliant outcomes for every processed claim.
Key Responsibilities
- Process health insurance claims using the HealthPay platform and closely review AI-generated outcomes.
- Crosscheck all details in each claim, including deductions, coverage decisions, and compliance with policy guidelines.
- Identify and correct inaccuracies introduced by the application, ensuring manual verification as needed.
- Compare claim outcomes against hospital documents (e.g., itemized bills, discharge summaries, policy documents).
- Document corrections and maintain clear, auditable records for every claim processed.
- Communicate patterns of common errors to the engineering team to support ongoing product improvement.
- Meet performance benchmarks on accuracy, turnaround time, and compliance standards.
- Liaise with internal teams to resolve complex issues or escalate claims requiring special handling.
Requirements
- 1–3 years of health insurance claim processing experience (TPA or hospital background preferred).
- Strong understanding of medical and non-medical claim components, policy documentation, and insurance rules.
- Proven ability to review structured data and supporting documents (PDFs, Excel).
- High attention to detail and commitment to error-free claim handling.
- Good documentation and record-keeping skills.
- Effective communication abilities for internal collaboration.
- Bachelor’s degree in Life Sciences, Pharmacy, Nursing, Healthcare Administration, or similar (preferred but not mandatory).
- Comfort using digital tools and learning new software platforms.
What We Offer
- Opportunity to work with leading-edge AI technology in health insurance.
- Fast-paced, growth-focused environment.
- Hybrid/remote work flexibility.
- Continuous learning and exposure to both healthtech and process automation.
Join Us
If you have a background in health claims processing and are ready to partner with innovative technology to deliver seamless insurance experiences, we invite you to apply. At HealthPay, you’ll play a crucial role in ensuring every claim is fair, timely, and accurate.
Job Type: Full-time
Pay: ₹200,000.00 - ₹400,000.00 per year
Benefits:
- Health insurance
- Provident Fund
Schedule:
- Monday to Friday
- Weekend availability
Supplemental Pay:
- Commission pay
- Performance bonus
Application Question(s):
- How many years have you worked in health insurance claim processing or TPA adjudication workflows?
- Can you explain what non-medical deductions and non-payables are in the context of health insurance?
- What steps do you take to ensure the accuracy and completeness of your work?
- How do you document your claim review process and communicate feedback to technical or operations teams?
- Describe a situation where you had to meet strict turnaround times (SLAs) while ensuring high quality.
Work Location: In person