Claims Executive

Hi,

We are Vitraya Technologies Private Limited, an IT product-based company specializing in delivering innovative software solutions to the insurance industry. Given our focus on the insurance sector, we require professionals with a medical background or a strong understanding of medical terminology and procedures.

We invite individuals who have completed medical-related courses such as Nursing BDS, MDS,FDS or an Insurance TPA Background, MBBS and are looking to transition from a clinical setting to a corporate environment.

Role Overview: We are looking for a Claims Executive with strong medical knowledge to process and scrutinize health insurance claims received from hospitals. The role involves verifying medical documents, checking policy coverage, and ensuring accurate and timely claim decisions.

Key Responsibilities

• Scrutinize cashless and reimbursement claims received from hospitals
• Verify medical documents such as discharge summary, investigation reports, prescriptions, and bills
• Check medical necessity, diagnosis, procedures, and treatment as per policy terms
• Validate ICD codes, procedure codes, room rent, and treatment charges
• Coordinate with hospitals, TPAs, and internal teams for missing or clarification documents
• Ensure claims are processed within defined TAT (Turnaround Time)
• Maintain accurate records and update claims in the system
• Support senior team members in complex or escalated cases

Required Skills & Medical Knowledge

• Good understanding of medical terminology, diagnosis, procedures, and treatments
• Knowledge of health insurance policies, exclusions, and admissibility rules
• Ability to read and interpret hospital medical records
• Basic understanding of ICD / CPT / medical coding (preferred)
• Attention to detail and analytical thinking
• Good communication and coordination skills

Educational Qualification

• Graduate in Life Sciences / Nursing / Pharmacy / BSc / GNM / BPT
• MBBS / BAMS / BHMS (Non-clinical role) – preferred but not mandatory

Your role will be crucial in ensuring the integrity and accuracy of medical claims, contributing to a streamlined and efficient claims process for our clients.

Job Type: Full-time

Benefits:

• Food provided
• Health insurance
• Provident Fund

Work Location: In person

Interested Candidates can apply at [email protected] or WhatsApp their resume at9999043348. Kindly mention “Applying for Claims Executive” while applying on email or sending it to WhatsApp along with your CV attached.

Job Type: Full-time

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

Benefits:

• Food provided
• Health insurance
• Provident Fund

Education:

• Doctorate (Required)

Work Location: In person