Ayushman Claim Processing (Hospital Operations)

Type- Full Time

Location- Bangalore

Mission of the Position

We are seeking a detail-oriented and efficient Ayushman Insurance claim processor to manage and

process insurance claims under the PMJAY scheme. The ideal candidate will ensure timely and accurate

processing of claims, maintain comprehensive records, and provide exceptional support to beneficiaries

and clients. The role would be office based and would largely involve claim review support to clients and

on-ground resources wherein the quality and accuracy of the claims processing would be the deliverable

expected from the role.

Primary Activities-

● Evaluate and process Ayushman Bharat insurance claims, ensuring compliance with guidelines and

policies.

● Verify the accuracy and completeness of claim documents submitted by beneficiaries and hospitals.

● Liaising with healthcare providers, beneficiaries, and insurance companies to resolve any discrepancies

or issues related to claims.

● Liaison with stakeholders pan India to provide virtual client support.

● Maintain accurate records of claims processed in the system and ensure timely updates.

● Ensure adherence to regulatory requirements and internal policies related to insurance processing.

● Provide assistance to beneficiaries regarding the claim process, including eligibility, documentation, and

status updates.

● Generate reports on claim processing metrics and identify areas for improvement.

● Responsible for operational efficiency & service delivery

● Ensure compliance with company's policies and operational guidelines

● Escalate related risks and concerns when necessary

● Should have strong client orientation and willingness to maintain a balanced approach when resolving

client complaints

● Create daily, weekly and monthly report on the performance for assigned clients

Must Have – Minimum Requirements

• Must be a graduate or equivalent with an MBA or Management degree preferred with 1-2 years of

relevant work experience. Should have at least experience of 1 Year in PMJAY/ Ayushman claim

processing management

• Experience of working in similar profile with healthcare program/ Client management in a prior role would be preferred
• He/she should be able to deal with ambiguity and navigate through challenges effectively
• Excellent communication in English & Hindi. Knowledge of other regional languages like Kannada is a bonus
• Should have sound knowledge of basic computer skills Microsoft Office and web-based portal

Personal Attributes-

• Exceptional interpersonal and organizational skills
• Planning for project implementations and adherence to timelines
• Strategic orientation combined with operational strength/task orientation
• Good influencing skills, able to persuade others to adopt specific courses of action
• Consultative approach and ability to build long-term relationships
• Can work autonomously but is also a team player
• Self-motivated and positive with “Can do” attitude
• Good time manager: Well organized, able to set and reset priorities

Interested candidates share your resume to hr@healspan.com