Claim Processing Executive (Health Insurance)

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