Executive / Senior Executive – Claims Registration & Claims Technical Adjudication
About the Role
Join one of India's leading health insurance companies and be a part of a dynamic Claims Inhousing team. We are looking for professionals with experience in Claims Registration and/or Technical Adjudication who are passionate about delivering quality claim decisions and ensuring an exceptional customer experience.
Role 1: Claims Registration
Key Responsibilities
- Register cashless and reimbursement claims accurately in the system.
- Verify policy details, member eligibility, and claim documents.
- Ensure complete documentation before claim processing.
- Coordinate with hospitals, TPAs, and internal stakeholders for pending requirements.
- Ensure quality and adherence to TAT.
- Preferred Experience: 2–5 years in Health Insurance/TPA Claims Registration.
Role 2: Claims Technical Adjudication
Key Responsibilities
- Perform technical evaluation of cashless and reimbursement claims.
- Review medical records, hospital bills, and policy terms.
- Assess medical necessity, non-medical expenses, and claim admissibility.
- Perform claim tabulation, including co-pay, deductibles, sub-limits, and final payable amount.
- Ensure compliance with IRDAI guidelines and internal SOPs.
- Handle complex claims while maintaining quality and TAT.
- Preferred Experience: 2–5 years in Health Insurance/TPA Technical Adjudication.
Why Join Us?
- Work with a leading Health Insurance organization.
- Exposure to end-to-end Claims Inhousing operations.
- Career growth and learning opportunities.
- Collaborative and employee-friendly work culture.
- PF, Mediclaim other benefits.
- Performance-driven environment with opportunities to grow.
Pay: ₹300,000.00 - ₹500,000.00 per year
Benefits:
- Health insurance
- Provident Fund
Work Location: In person
