Claim Processing Executive

Job Description

Job Title: Claims Registration Executive

Level: Executive/ Senior Executive (0-3 years experience)

Key Responsibilities:

Claim Initiation & Registration: Receive and register claims (Cashless Pre-authorization or Reimbursement) via email, online portals, mobile apps, or phone, ensuring all details are logged in the Claims Management System (CMS).
Document Verification: Verify policyholder eligibility, coverage, and the completeness of documents (e.g., claim form, discharge summary, medical bills, investigation reports).
Data Accuracy: Ensure accurate data entry of patient details, diagnosis codes, and hospital information into the system.
Inter-departmental Coordination: Coordinate with Third Party Administrators (TPAs), hospitals, and internal medical teams for smooth claim handling.
Communication: Handle customer queries regarding claim procedures, status, and outstanding requirements via phone or email.
Confidentiality & Compliance: Ensure compliance with company policies, regulatory guidelines (e.g., IRDAI), and maintain the confidentiality of medical records.
Record Maintenance: Maintain and scan claim documents securely, creating proper logs and reports.

Required Skills & Qualifications:

Education: Bachelor’s degree in any discipline.
Experience: 1-3 years of experience in insurance claims.
Technical Skills: Proficiency in MS Excel and MS Office; familiarity with Claims Management Software is preferred.
Domain Knowledge: Basic understanding of health insurance policies, medical terminology, and TPA procedures.