Claims Executive

Policy Decoding Executive

Company Description

Care.fi is a new age Health fintech startup in Gurgaon, offering smart financing and claim management solutions to hospitals.

With a focus on driving efficiencies through technology, Care.fi provides seamless financing and revenue cycle management solution for healthcare providers. The company has strong institutional investor backing and founders with over 20 years of experience in the industry.

Role Description

As a Policy Decoding Executive, you will be responsible for handling health-related insurance claims processing, policy decoding, and follow-up on insurance settlements. This role requires meticulous attention to detail, effective communication and good knowledge of the healthcare and insurance processes. The ideal candidate should be able to manage bill validation, coordinate with stakeholders and ensure timely claim settlements.

Key Responsibilities:

• Policy Decoding

  : Review and interpret health insurance policies to ensure accurate claims processing; Call insurance companies and check with TPA/Insurance portals to understand the coverage of policy

• Bill Validation

  : Assess and validate hospital bills to verify treatment and service accuracy, ensuring alignment with policy coverage

• Insurance Follow-up

  : Engage with insurance companies to monitor claim statuses and follow up on pending approvals and settlements

• Settlement Management

  : Ensure timely settlement of claims, resolving any discrepancies between billed amounts and insurance coverage; Follow-up with patients to recover the pending amount

• Dispatch

  : Manage the final stages of the claims process, including the dispatch of settlement documents or other related paperwork

Requirements:

• 1-3 years of experience in a similar role, preferably in healthcare or insurance sectors
• Strong understanding of medical billing, healthcare policies and insurance claims
• Proficiency in Microsoft Office (Excel, Word)
• Excellent communication skills for coordinating with hospitals and insurance companies.
• Strong analytical abilities and attention to detail
• Ability to work in a fast-paced environment and manage multiple tasks simultaneously
• Open to work 6 days a week from office