Health Claims Manager

Job description

Hiring: Medical Officer Health Claims **Experience:** 3-4 Years **Qualification:** MBBS / BAMS / BHMS **Industry:** General Insurance / Health Insurance / TPA **Key Responsibilitie**s: - Review and process cashless health insurance claims. - Assess claims as per policy terms, medical guidelines, and SOPs. - Approve, deny, or raise queries on cashless requests. - Evaluate hospital bills and determine payable amounts. - Provide medical opinions and handle clinical queries from hospitals/customers. - Ensure accurate claims adjudication, ICD coding, and cost management. - Maintain TAT, productivity, and quality standards with processing errors below 0.25%. - Collaborate with internal teams to ensure faster claim settlement and enhanced customer experience. - Prepare MIS reports and support operational excellence initiatives. **Requirements:** - 3-4 years of health claims processing experience in Insurance/SAHI/TPA. - Strong understanding of medical terminology, claims adjudication, and policy interpretation. - Good analytical, communication, and stakeholder management skills. - Proficiency in MS Office. - Insurance certification preferred. **Shift Timings:** Rotational shifts between 8:00 AM 10:00 PM for Males(for females: 8:00 AM 8:00 PM). - Proficiency in MS Office. - Insurance certification preferred.