5 Claims Processes Jobs

As a professional in the insurance industry, you will have the responsibility of negotiating with Insurance Agencies to finalize the Terms and Conditions of Policies and Premiums. It will be your duty to ensure a smooth onboarding and renewal process with the Insurance Agencies. Your role will entail obtaining approval for all credit limits from the Insurance Agency prior to client onboarding and ensuring the timely sharing of relevant MIS files. Additionally, you will be accountable for the timely filing of NNP and claims, as well as ensuring the submission of all necessary documents for claims processing. Moreover, you will play a crucial role in setting up Standard Operating Procedures (SOPs) and Policies for the end-to-end Insurance process. Your expertise will be required in maintaining MIS records related to NNP, Claims, and other relevant areas. To excel in this role, you should possess experience in managing relationships with insurance agencies and familiarity with onboarding processes. A deep understanding of insurance policies, claims procedures, and industry standards will be essential. Proficiency in credit limit management and claims submission processes is also crucial. Proficiency in Microsoft Office Suite, particularly Excel, Word, and PowerPoint, will be advantageous for effective performance in this position.,

As an Insurance Claims Manager at InsuGo Insurance Brokers, you will be responsible for overseeing and processing insurance claims. Your role will involve reviewing and validating claims, offering guidance to clients, negotiating with insurers and other stakeholders, preparing reports, mentoring junior staff, maintaining accurate documentation, and compiling data for management reporting. You will review all relevant documents pertaining to claims to ensure compliance with policy terms and conditions. Providing clear and comprehensive advice to clients on the claims process will be crucial, as you guide them through claim submissions and required documentation. Resolving disputes and reaching mutually beneficial solutions that align with policy terms and client expectations will be part of your responsibilities. Additionally, you will compile detailed reports on claims activities for analysis and review. It will be essential to ensure accurate filing and secure maintenance of all claims-related documents, in adherence to company policies and regulatory requirements. Gathering and analyzing claims statistics and data for management reporting will also be a key aspect of your role. To qualify for this position, you should hold a Bachelor's degree in Insurance, Finance, Business Administration, or a related field. A minimum of 3 years of experience in insurance claims management or a similar role is required. A strong understanding of insurance policies, claims processes, and regulatory requirements is essential. Excellent analytical and problem-solving skills, proficiency in claims management software and Microsoft Office Suite, as well as attention to detail and effective multitasking abilities are desired skills for this role. If you are looking to join a dynamic team in an emerging insurance broking service provider, where you can grow both individually and professionally while contributing significantly to the workplace, we encourage you to share your resumes with us at info@insugo.in or hr@insugo.in.,

You will play a crucial role in supporting various initiatives that enhance the healthcare financial experience at Zelis India. Your responsibilities will include managing the settlement of provider claims, acting as a specialist for the team. This position requires strong negotiation skills, a deep understanding of claims processes, and the ability to support and guide junior team members. Your duties will involve investigating and settling provider and client billing inquiries, including renegotiating claims to secure savings and meet or exceed department KPI goals. You will also be responsible for maintaining comprehensive tracking and documentation of all necessary information related to the research and settlement of assigned work. Collaboration with internal teams, such as Client Services, Network and Vendor Management, Out of Network Services, and Bill Review & Audit, will be essential to ensure timely issue resolution. Furthermore, you will be expected to recommend process improvement opportunities within your team's scope and communicate directly with clients to provide status updates and resolved issue notifications to maintain strong customer relations. Adherence to HIPAA and company standards regarding privacy and confidentiality is paramount in this role. Additionally, you will provide support for the Customer Care Team when required and perform any other related responsibilities as assigned. To excel in this position, you should have 3-5 years of experience in medical claims settlement and 5+ years of experience within the healthcare industry. A strong understanding of PPO networks and the ability to interpret Explanation of Benefits, Plan Documents, PPO, and Complementary Network discounts are essential. Outstanding written and verbal communication skills, proficiency in MS Outlook, MS Word, MS Excel, and Internet Explorer, excellent prioritization and organizational skills, and exceptional customer service and telephone communication skills are also required. An Associates Degree is required for this role, while a Bachelor's Degree is preferred to further support your professional growth and development.,

You are a qualified and experienced medical professional sought to join the insurance operations team to handle and review Group Personal Accident (GPA) and Group Mediclaim (GMC) claims. Your responsibilities include ensuring the accuracy and appropriateness of claims, resolving medical disputes, addressing client grievances, and providing expert support in claim-related discussions with insurers and clients. Your key responsibilities will involve scrutinizing GPA and GMC claims from a medical perspective, handling disputed or complex claims such as accidental disability or death due to medical or accidental causes, and liaising with insurance company doctors and TPAs to resolve disputes based on clinical merit. Furthermore, you will be responsible for managing medical grievances, addressing customer concerns with medical aspects or claim rejections, and coordinating with corporate clients, insurance company medical teams, TPAs, and legal teams when necessary to ensure clarity and resolution on medical matters. Maintaining detailed and confidential medical case notes for claims handled, documenting recommendations, approvals, and medical assessments, and ensuring alignment with internal policies and industry regulations will also be part of your duties. To excel in this role, you should possess strong clinical evaluation and documentation review skills, a good understanding of insurance terms and claims processes, the ability to assess disability and accidental claims from a medico-legal standpoint, excellent communication and interpersonal skills, and a problem-solving mindset with attention to medical and procedural details. Your qualifications should include an MBBS/BAMS/BHMS degree, with additional qualifications in insurance or healthcare administration being advantageous. You should have at least 3-5 years of experience in medical claims review in the insurance or TPA industry, along with familiarity with claim adjudication processes in Group Health and Personal Accident Insurance.,

Role & responsibilities Oversee and manage the end-to-end claims process, ensuring timely processing and adherence to internal policies Analyze claims data to identify trends, assess process gaps, and evaluate financial impact Prepare and present reports including claim status, pending settlements, and loss projections to senior management Collaborate with internal teams and external partners to resolve operational challenges and enhance efficiency Act as the primary point of contact for claim-related insights, fostering clear communication among stakeholders Identify and implement best practices to improve claim management accuracy and efficiency