Health Claim Executive

Job Summary:

We are looking for a dedicated and detail-oriented Health Claim Executive to manage and process health insurance claims efficiently. The ideal candidate should have a good understanding of health insurance policies, claim procedures, and relevant documentation. This role is crucial in ensuring timely and accurate settlement of claims while providing excellent customer service.

Key Responsibilities:

• Scrutinize and verify claim documents submitted by clients/hospitals.
• Coordinate with hospitals, TPAs, and policyholders for claim-related queries.
• Evaluate claims based on policy terms, conditions, and exclusions.
• Process cashless and reimbursement claims in a timely manner.
• Ensure all claims are processed as per company guidelines and within the TAT (Turnaround Time).
• Maintain accurate claim records and update internal systems.
• Follow up with internal teams and external stakeholders for pending documentation.
• Identify fraudulent or suspicious claims and report accordingly.
• Provide claim status updates and support to customers.
• Assist in claim audits and MIS reporting.

Required Qualifications & Skills:

• Graduate in any discipline (B.Com, B.Sc., BBA preferred).
• 1–3 years of experience in health insurance claim processing or related field.
• Knowledge of health insurance products and IRDA regulations.
• Familiarity with cashless and reimbursement claim procedures.
• Proficiency in MS Office and claim management software.
• Strong communication (verbal and written) and interpersonal skills.
• Ability to handle pressure and multitask.
• Customer-focused approach with problem-solving abilities.

Job Type: Full-time

Pay: ₹12,000.00 - ₹15,000.00 per month

Schedule:

• Day shift

Work Location: In person

Speak with the employer
+91 9499809302