Job Description

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