Senior Manager/Manager - Health Claims

Job Description

Role: Senior Manager/Manager - Health Claims (Claims Processing) Job location: Goregaon East Role & responsibilities Experience: 2+ years (preferably with Insurer/TPA) Key Responsibilities: Process and review health insurance claims in line with policy and regulatory guidelines. Verify clinical documents (discharge summaries, prescriptions, medical reports) for claim validation. Coordinate with TPAs, brokers, and clients for claim-related queries and document collection. Manage client escalations related to claim disputes or delays. Review and reject claims where necessary, providing clear reasons and communication Ensure compliance with health insurance regulations and company policies. Prepare reports on claim processing status and outcomes. Suggest process improvements to enhance efficiency and accuracy. Qualifications & Skills: Degree in BAMS, BHMS, MBBS, or Dentistry. Minimum 2 years experience in health claims processing with insurers or TPAs. Good understanding of insurance products, claims procedures, and regulatory requirements. Strong analytical, communication, and coordination skills. Proficient with MS Office and claims management tools. Ability to handle multiple tasks and client interactions effectively.

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