Job Description

Key Responsibilities:

Review and process

cashless and reimbursement claims

submitted by policyholders or hospitals.

Scrutinize medical documents

and verify claim eligibility as per policy terms. Coordinate with

TPAs, hospitals, internal teams, and customers

for claim-related queries and clarifications. Maintain accurate records and update claim status in the system. Flag and escalate

suspicious or fraudulent claims

to the investigation team. Ensure

timely settlement

of claims within defined TATs. Provide support in

claim audits and reporting

. Maintain adherence to

IRDAI guidelines and internal SOPs

.

Required Skills & Competencies:

Strong

attention to detail

and analytical ability. Good understanding of

health insurance processes

(for experienced candidates).

Basic knowledge of medical terminology

is preferred. Excellent

communication skills

(written and verbal). Ability to handle

customer queries

with patience and professionalism. Proficient in

MS Office and claims management systems

(training will be provided to freshers).

Eligibility Criteria:

Educational Qualification:

Graduate (preferably in Life Sciences, Pharmacy, Nursing, or any related field).

Experience:

Freshers

with good communication and willingness to learn can apply. Experienced candidates in health claims, TPA, or hospital billing will be preferred.
Job Types: Full-time, Permanent

Pay: ₹25,000.00 - ₹35,000.00 per month

Benefits:

Health insurance Leave encashment Paid sick time Paid time off Provident Fund
Schedule:

Day shift Fixed shift Morning shift
Application Question(s):

How many years of experience do you have in Health Insurance, Claims, in Indian Process
Do you have experience of Health Claims in Indian Process
Do you have experience of handling clients over call and solve their queries

Experience:

Insurance: 2 years (Required)
Language:

English (Required) Rate your English communication skill out of 10
(Required)
Location:

Gurugram, Haryana (Required)
Work Location: In person