We are looking for a detail-oriented and process-driven Claim Processing Executive (CRM) to handle health insurance claims efficiently and accurately. The role involves verifying claim documents, coordinating with hospitals/TPAs/customers, ensuring policy compliance, and processing claims within defined timelines while maintaining high service standards.
Key Responsibilities
- Review and process health insurance claims as per company policies and regulatory guidelines.
- Verify claim documents including hospital bills, discharge summaries, prescriptions, investigation reports, and policy details.
- Coordinate with hospitals, TPAs, insurance companies, and customers for additional documentation or clarifications.
- Ensure claims are processed within agreed turnaround time (TAT).
- Identify discrepancies, incomplete documentation, or fraudulent claims and escalate appropriately.
- Maintain accurate records and update claim status in the system.
- Handle customer queries related to claim status, approvals, rejections, and settlements.
- Ensure compliance with internal processes, IRDAI regulations, and company policies.
- Prepare MIS reports and maintain claim processing data.
- Work closely with underwriting, customer support, and finance teams for smooth claim settlement.
Required Skills & Competencies
- Good understanding of health insurance claim processes.
- Knowledge of medical terminology and hospital documentation preferred.
- Strong attention to detail and analytical skills.
- Good communication and coordination skills.
- Ability to work under pressure and manage deadlines.
- Proficiency in MS Excel and claim management software.
- Strong documentation and record-keeping abilities.
Eligibility Criteria
- Graduate in any discipline.
- Prior experience in health insurance claims processing/TPA/hospital insurance desk preferred.
- Freshers with relevant knowledge or certification may also apply.
Experience
- 0–3 years of experience in health insurance claims processing.
Location
- Multiple locations in India
Working Days & Timings
- Mon - Sat; 9.30am to 6.30pm
Preferred Industry Background
- Health Insurance
- TPA (Third Party Administrator)
- Hospitals / Healthcare
- Insurance Broking Companies
Pay: ₹18,000.00 - ₹25,000.00 per month
Benefits:
- Paid sick time
- Paid time off
- Provident Fund
Work Location: In person
