Associate- Health Insurance, Claims

Key Responsibilities:

• Review and process cashless and reimbursement claims submitted by policyholders or hospitals.
• Scrutinize medical documents and verify claim eligibility as per policy terms.
• Coordinate with TPAs, hospitals, internal teams, and customers for claim-related queries and clarifications.
• Maintain accurate records and update claim status in the system.
• Flag and escalate suspicious or fraudulent claims to the investigation team.
• Ensure timely settlement of claims within defined TATs.
• Provide support in claim audits and reporting.
• Maintain adherence to IRDAI guidelines and internal SOPs.

Required Skills & Competencies:

• Strong attention to detail and analytical ability.
• Good understanding of health insurance processes (for experienced candidates).
• Basic knowledge of medical terminology is preferred.
• Excellent communication skills (written and verbal).
• Ability to handle customer queries with patience and professionalism.
• Proficient in MS Office and claims management systems (training will be provided to freshers).

Eligibility Criteria:

• Educational Qualification: Graduate (preferably in Life Sciences, Pharmacy, Nursing, or any related field).
• Experience:
• Freshers with good communication and willingness to learn can apply.
• Experienced candidates in health claims, TPA, or hospital billing will be preferred.

Job Types: Full-time, Permanent

Pay: ₹25,000.00 - ₹35,000.00 per month

Benefits:

• Health insurance
• Leave encashment
• Paid sick time
• Paid time off
• Provident Fund

Schedule:

• Day shift
• Fixed shift
• Morning shift

Application Question(s):

• How many years of experience do you have in Health Insurance, Claims, in Indian Process ?
• Do you have experience of Health Claims in Indian Process ?
• Do you have experience of handling clients over call and solve their queries ?

Experience:

• Insurance: 2 years (Required)

Language:

• English (Required)
• Rate your English communication skill out of 10 ? (Required)

Location:

• Gurugram, Haryana (Required)

Work Location: In person