Claims Management Specialist

As a Claims Management Specialist, your primary role is to process and manage cashless insurance claims efficiently and accurately. You will be responsible for ensuring timely closure to policyholders and maintaining seamless coordination with insurance providers. Key Responsibilities: - Act as a Claims buddy by managing end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring accurate and efficient processing. - Verify Policy Coverage by reviewing and confirming policy details to ensure that the claim is eligible for cashless processing according to the insurance policy's terms and conditions. - Provide Customer Service by responding to inquiries from employees and other stakeholders regarding claim status and addressing any related queries. - Coordinate with Healthcare Providers/Hospitals to communicate, obtain additional information, and clarify details whenever necessary. - Resolve Issues by investigating and addressing any discrepancies, errors, or issues that may arise during the processing of cashless claims to ensure timely and accurate resolution. - Maintain Records by accurately documenting all claim-related activities, communications, and transactions for documentation and audit purposes. - Adhere to Service Level Agreements by meeting or exceeding established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction. - Aim to achieve a Net Promoter Score (NPS) of 92+ in the cashless claims handled. Qualifications Required: - At least 2 years of experience in customer-facing roles. - Past experience in a voice profile would be an added advantage. - Experience in cashless/Third Party Administrator (TPA) operations.,