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Dedicated Claims Specialist

Dedicated Claims Specialist

Loop

2 - 4 years

2 - 5 Lacs

Mumbai

Posted:3 weeks ago| Platform:

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Skills Required

Health insurance Document review TPA Corporate Healthcare Customer support Customer service Medical insurance Claims processing CRM

Work Mode

Work from Office

Job Type

Full Time

Job Description

About the role : We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: Bachelor s degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

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