Health Operations

Department: Health Insurance : Claims operations

Designation : Executive / Senior Executive

Location : Jaipur ( Corporate Office )

Mail ID - [email protected]

Nature- On Roll

Salary Range – As per Industry Norms.

Qualification: B.Sc Nursing / B. Pharma

Experience - 1years + in relevant field / Freshers can also apply

Job Description

• We are seeking a detail-oriented Health Operations Claims Associate/Executive to support health insurance claims operations.
• The role involves reviewing claim submissions, assessing medical documentation, coordinating with healthcare providers, processing claim settlements, and ensuring compliance with claims guidelines and regulatory requirements.

Key Responsibilities

• Review health insurance claim forms and supporting medical documents.
• Coordinate with hospitals, TPAs, and customers for additional document collection or clarification.
• Support claim processing, adjudication, and settlement activities.
• Follow up with customers and branches for pending requirements.
• Maintain claims records, MIS reports, and operational dashboards.
• Ensure compliance with company policies and regulatory requirements.
• Meet turnaround time (TAT) and service-level agreement (SLA) targets.

Required Skills

• Knowledge of health insurance and claims processes.
• Analytical and risk assessment skills.
• Good communication and coordination skills.
• Proficiency in MS Excel and operational systems.