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 Responsibilities: • 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.