Domestic Health Insurance Claims Executive

Position: Claims Officer

Transcom is Hiring! Health Insurance claims Executive (Day Shift Premium Process)Are you passionate about helping people protect their health and future?

*Role & responsibilities

Role:

Key Responsibilities:

• Act as a Claims Guide:

  End-to-end management of cashless/reimbursement escalated claims. This includes verifying policy coverage, reviewing medical records, coordinating with insurers, suggesting documents for reconsideration and ensuring that claims are processed efficiently.

• Verify Policy Coverage and Eligibility:

  Review and verify policy details and nuances of customers health to ensure that the claim is eligible for processing according to the terms and conditions.

• Coordinate with Stakeholders:

  Coordinate with insurers and TPAs to obtain additional information, challenge unfair decisions, clarify details, and drive timely claim resolution.

• Provide Exceptional Customer Service:

  Serve as the point of contact for resolving customer concerns in escalated claim cases. Ensure all customer-facing communication meets standards of empathy and clarity to enhance the client experience.

• Strategic Reporting & Optimization:

  Track and report on insurer-wise performance and claim cycle times. Utilize these insights to optimize claims processing and overall experience.

Ideal Candidate:

• Experience:

  2-4 years in health insurance claims processing. Must have prior experience of working in the insurance/TPA industry.

• Education:

  Bachelors degree in life sciences / pharmacy / medical science / nursing is

  preferred.

• Display a strong understanding of health insurance claims and related regulations/terminologies.

• Core Skills:

  Negotiation, Problem-Solving, Attention to Detail, Resilience, and Clear Communication.

Key Performance Indicators (KPIs)

• Resolution TAT for Escalated Claims:

  Measures the speed and effectiveness in resolving claims concerns. This is the primary KPI.

• Customer Satisfaction (CSAT):

  Measures customer happiness with the handling and outcome of their claim issues.

Claims Cycle Time (Insurer-wise Analysis):

Shift:

6 days wroking 1 rotational week off

Location:

CONTACT PERSON -

Email ID:-gayatri.soni@transcom.com

Role: