Health Claim Manager

Key Responsibilities

1. Customer Interaction & Medical Guidance

• Handle inbound calls from customers requesting a second medical opinion.
• Review medical documents, reports, prescriptions, and diagnostic findings shared by customers.
• Provide clear, accurate, and ethical medical advice to help customers understand their diagnosis and treatment options.
• Offer guidance on alternative treatments, specialist referrals, and clinical pathways when relevant.
• Maintain empathy, respect, and professionalism in all customer interactions.

2. Clinical Assessment & Documentation

• Document all customer interactions, medical assessments, and advice provided in the system.
• Summarize key clinical observations and recommendations in easytounderstand language for customers.
• Identify cases that require escalation to senior medical experts or specialized departments.
• Ensure medical records are handled with utmost confidentiality and comply with data-protection guidelines.

3. Coordination & Collaboration

• Work closely with internal teams such as Claims, Customer Support, and Medical Underwriting for medical clarification.
• Provide inputs to claims teams when a customers medical understanding may impact claim decisions.
• Coordinate with network hospitals whenever additional clinical information is required.

4. Compliance & Quality Assurance

• Ensure all guidance is aligned with medical ethics and regulatory requirements.
• Follow the insurers protocols for customer communication and documentation.
• Participate in quality audits, training sessions, and continuous medical education modules.
• Adhere to SLAs for call handling, documentation accuracy, and customer satisfaction.

Work Location:- Indore, Madhya Pradesh.

Interested candidates can share their resume on [email removed] and [phone removed]