Medical Claims Processor - Health Insurance

Role : Senior Manager - Medical Claims Processor - Health Insurance

Job Location: Goregaon East

Industry: Health Insurance / TPA / Health-Tech / General Insurance

Educational Qualification : BAMS / BHMS / BPT / BDS preferred.

Key Responsibilities

• To accurately assess, adjudicate, and process health insurance claims in accordance with policy terms, underwriting guidelines, regulatory requirements, and internal claim management procedures while ensuring superior customer service and operational efficiency.
• Scrutinize claim documents including discharge summaries, investigation reports, prescriptions, hospital bills, policy schedules, and claim forms.
• Interpret medical records and treatment protocols for various disease conditions.
• Coordinate with medical experts, hospitals, and investigation agencies whenever required.
• Resolve claim queries and escalations within defined timelines.

Skills Required

• Strong medical and insurance knowledge.
• Analytical and decision-making skills.
• Attention to detail and accuracy.
• Proficiency in claims processing systems.
• Good Knowledge of Hospital billing practices & packages rates.