Job Summary:
We are looking for a dedicated and detail-oriented Health Claim Executive to manage and process health insurance claims efficiently. The ideal candidate should have a good understanding of health insurance policies, claim procedures, and relevant documentation. This role is crucial in ensuring timely and accurate settlement of claims while providing excellent customer service.
Key Responsibilities:
- Scrutinize and verify claim documents submitted by clients/hospitals.
- Coordinate with hospitals, TPAs, and policyholders for claim-related queries.
- Evaluate claims based on policy terms, conditions, and exclusions.
- Process cashless and reimbursement claims in a timely manner.
- Ensure all claims are processed as per company guidelines and within the TAT (Turnaround Time).
- Maintain accurate claim records and update internal systems.
- Follow up with internal teams and external stakeholders for pending documentation.
- Identify fraudulent or suspicious claims and report accordingly.
- Provide claim status updates and support to customers.
- Assist in claim audits and MIS reporting.
Required Qualifications & Skills:
- Graduate in any discipline (B.Com, B.Sc., BBA preferred).
- 1–3 years of experience in health insurance claim processing or related field.
- Knowledge of health insurance products and IRDA regulations.
- Familiarity with cashless and reimbursement claim procedures.
- Proficiency in MS Office and claim management software.
- Strong communication (verbal and written) and interpersonal skills.
- Ability to handle pressure and multitask.
- Customer-focused approach with problem-solving abilities.
Job Type: Full-time
Pay: ₹12,000.00 - ₹15,000.00 per month
Schedule:
- Day shift
Work Location: In person
Speak with the employer
+91 9499809302
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