Claims Specialist

As a Claims Management Specialist, your main role is to efficiently and accurately process and manage cashless insurance claims, ensuring timely closure for policyholders and seamless coordination with insurance providers. You will be responsible for verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring that claims are processed accurately and efficiently. Additionally, you may need to communicate with employees or dependents to provide updates on claim status and address any questions or concerns to facilitate the smooth and timely processing of cashless claims. Your key responsibilities will include: - Managing end-to-end cashless claims of employees, including verifying policy coverage, reviewing medical records, and ensuring accurate processing - Reviewing and verifying policy details to determine claim eligibility for cashless processing - Providing customer service by responding to inquiries regarding claim status and other related queries - Communicating with healthcare providers to obtain additional information and clarify details as needed - Investigating and resolving any discrepancies, errors, or issues that arise during claim processing - Maintaining detailed and accurate records of all claim-related activities for documentation and audit purposes - Adhering to service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction - Striving to achieve an NPS of 92+ in the cashless claims handled In terms of qualifications, we are looking for candidates who: - Have at least 2 years of experience in customer-facing roles - Possess past experience in a voice profile, which would be an added advantage - Have experience in cashless or TPA processes In addition, you will interact with various internal and external clients, including endorsement teams, onboarding teams, product and engineering teams, claims teams, support inbound teams, account management teams, insurers, client HRs, and hospitals. If you meet the qualifications and have the necessary experience, we encourage you to apply for this Claims Management Specialist position.,