Walk-in || Claims Executive

Key Responsibilities:

• Process Health Claims files accurately and efficiently.
• Perform Claim Registration and Claim Adjudication as per company guidelines.
• Review claims and identify potential fraudulent activities.
• Ensure adherence to defined Service Level Agreements (SLAs) and process claims within the stipulated Turnaround Time (TAT).
• Verify claim documents and assess eligibility as per policy terms and conditions.
• Coordinate with CRM, Provider, Sales, and Grievance teams for claim-related support and resolution.
• Maintain high standards of quality, accuracy, and compliance in claim processing.
• Respond to internal and external queries related to claims in a timely manner.
• Support continuous process improvement initiatives to enhance operational efficiency.

Key Skills Required

• Health Claims Processing
• Claim Adjudication
• Claim Registration
• Fraud Detection
• Health Insurance
• Medical Claims
• SLA & TAT Management

Eligibility

• Pharm-D, B.Sc Nursing, or B.Pharmacy Freshers (with all certificates in hand).
• Any Graduate with a minimum of 2 years' experience in Health Claims Processing.