Job Description

Vidal is hiring for Claims-Executive/Team leader Level

Gurgaon Location.

Udhyog Vihar,Sector 19 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

1-3 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 - ?28,000.00 per month

Experience:

total work: 1 year (Preferred)
Work Location: In person