Health Insurance Claim Specialist

We are seeking an experienced Health Insurance Claims Management professional to join our dynamic team in a fully remote capacity. This role offers excellent growth potential with performance-based compensation that rewards efficiency and excellence in claims processing.

Job Details

• Position Type:

  Full-time, Remote

• Department:

  Claims Management

• Reports to:

  Director

Compensation Package

• Base Salary:

  INR 10,000 per month

• Performance Pay:

  INR 5,000 - INR 50,000 per month (based on number of claims processed)

• Total Potential Earnings:

  INR 15,000 - INR 60,000 per month

Key Responsibilities

• Process and manage health insurance claims efficiently and accurately
• Review claim documentation and verify coverage eligibility
• Coordinate with healthcare providers, policyholders, and internal teams
• Handle cashless claim approvals and settlements
• Maintain detailed records of all claim activities
• Ensure compliance with regulatory requirements and company policies
• Investigate and resolve claim discrepancies
• Provide excellent customer service throughout the claims process
• Meet monthly productivity targets for claim processing
• Generate reports on claim status and processing metrics

Required Qualifications

• Minimum 2 years of experience

  in health insurance claims management

• Mandatory experience with Cashless Everywhere/Anywhere Cashless

  systems and processes
• Strong understanding of health insurance policies and procedures
• Knowledge of medical terminology and coding systems
• Proficiency in claims management software and databases
• Excellent analytical and problem-solving skills
• Strong attention to detail and accuracy
• Effective communication skills (written and verbal)
• Ability to work independently in a remote environment
• Bachelor's degree preferred (relevant experience may substitute)

Preferred Qualifications

• Experience with multiple insurance carriers and TPA systems
• Knowledge of regulatory compliance requirements
• Previous experience in a remote work environment
• Certification in health insurance or claims management

Technical Requirements

• Reliable high-speed internet connection
• Dedicated workspace for remote work
• Proficiency in MS Office Suite
• Ability to learn new software systems quickly

Performance Metrics

Monthly compensation will be determined based on:

• Number of claims processed per month
• Accuracy rate in claim processing
• Customer satisfaction scores
• Turnaround time for claim resolution
• Compliance with quality standards

What we offer

• Competitive performance-based compensation structure
• Flexible remote work arrangement
• Professional development opportunities
• Supportive team environment
• Growth potential within the organization

Application Process

hr@upspike.in