Claim Processing Executive

2 - 5 years

3 Lacs

Posted:22 hours ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

Vidal is hiring for claim Processor

Designation: Executive-Claims

Location: Gurgaon,

Key Responsibilities:

  • Review and validate claim documents submitted by hospitals or insured members
  • Scrutinize medical records and bills for completeness and accuracy
  • Apply policy terms, conditions, and exclusions to adjudicate claims
  • Perform ICD and procedure coding as per ailment and treatment
  • Coordinate with medical officers for clinical opinion when required
  • Maintain claim logs and update CRM systems with claim status
  • Ensure adherence to defined SLAs and minimize processing errors
  • Flag suspicious or potentially fraudulent claims for investigation
  • Communicate with stakeholders for clarifications or missing documents
  • Support audit and compliance teams with documentation and reports
  • Shortfalls & Queries

Required Skills & Competencies:

  • Strong understanding of health insurance policies and TPA workflows
  • Familiarity with medical terminology and coding (ICD, CPT)
  • Attention to detail and analytical thinking
  • Proficiency in claims processing software and MS Office tools
  • Good written and verbal communication skills
  • Ability to manage high volumes under pressure
  • Commitment to confidentiality and data protection norms

Qualifications & Experience:

  • Graduate in any discipline (preferably life sciences or healthcare)
  • 1-3 years of experience in claims processing within a TPA or insurer

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