Walk-in || Claims Manager

Job Responsibilities:

• Apply medical knowledge to evaluate health insurance claim files and determine medical admissibility.
• Review and interpret policy wordings, terms, and conditions to adjudicate claim approvals or rejections.
• Process claims in accordance with regulatory and organizational guidelines.
• Ensure adherence to defined Turnaround Times (TATs) for claim processing.
• Conduct quality reviews of processed claims to maintain accuracy and compliance.
• Handle grievance redressal and claim-related escalations effectively.
• Identify and investigate potentially fraudulent claims.

Required Skills & Understanding:

• Preferably candidates with experience in Insurance or TPA (Third Party Administrator) operations.
• Strong clinical acumen and understanding of hospital processes and medical procedures.
• Knowledge of treatment protocols and diagnostic protocols.
• Ability to analyze medical records and documentation accurately.
• Good communication and decision-making skills.

Work Requirements:

• Ready to work from the office (No Work From Home).
• Flexible to work in rotational shifts.
• Comfortable with rotational weekly offs.

Freshers and experienced BAMS/BHMS candidates are encouraged to apply.