Customer Relationship Manager

Role & responsibilities

Handling Rejected claims and informing the reason for rejection to the customer and coordinating with TPA's and internal doctors.

Job Summary:

medical professional

Key Responsibilities:

• Medical Review & Claims Adjudication:

• Assess and validate medical claims based on clinical documentation and policy coverage.
• Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility.
• Coordinate with internal medical teams to ensure accuracy in claims decision-making.

• Customer Interaction & Support: Customer Calling - In Bound / Out Bound

• Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner.
• Handle escalated or complex customer service issues involving medical claims.
• Offer support and guidance on claim submission processes and documentation requirements.

• Compliance & Documentation:

• Ensure all claims are processed in compliance with IRDAI regulations and internal guidelines.
• Maintain accurate records of claim assessments, approvals, denials, and communications.

Required Qualifications:

• Education:

• BHMS, BAMS,BUMS, Pharmd or equivalent medical degree. Postgraduate qualifications in healthcare or insurance are a plus.