Claims Specialist

We have exciting opportunities for the role of AVP- Claim Review.

Location: Mumbai - Prabhadevi

AVP- Claim Review

Current Salary

Expectation

Notice Period

Education (Full Time / part Time)

Role Overview

The Claim Review Specialist will be responsible for reviewing medical claim rejections, ensuring due diligence, and enhancing customer experience through accurate and accountable claim assessments. The role requires strong medical knowledge, analytical capability, and the ability to contribute individually across claim processes. The candidate will also act as a Customer Ambassador by maintaining service quality and process transparency.

Key Responsibilities

1. Claim Review

• Review claim rejections in detail to ensure fairness and accuracy.
• Conduct due diligence on all claims, with a strong focus on customer empathy and accountability therein.

2. Process Contribution

• Act as an individual contributor for end-to-end claim processes.
• Achieve and improve claim process efficiency and quality parameters.
• Support claim operations and coordinate effectively with stakeholders.

3. Customer Advocacy

• Represent the customer's perspective during claim assessment.
• Ensure communication is clear, empathetic, and customer-centric.

4- Stakeholders Liaison

Required Skills & Knowledge

• Strong understanding of underwriting (UW), claims evaluation, and medical/product knowledge.
• Excellent communication skills (verbal & written).
• Solid SOP (Standard Operating Procedure) understanding.
• Ability to work independently and manage performance KPIs.
• Must be able to work from office

Qualification

• Medical background: **MBBS / BHMS / BUMS / BAMS** (preferred).
• Experience in **Insurance and/or TPA** environments is desirable.
• Minimum **10 years of experience** in claims operations or related medical review roles.

Regards,

Saba