Walk-in || Manager - Health Claims (Non-medical)

Role & responsibilities

• Adjudicate medical claims across both Cashless and Reimbursement channels as per policy terms and conditions.
• Review and validate claim documents to determine admissibility and liability.
• Assess and determine accurate claim payouts.
• Ensure compliance with internal guidelines, underwriting norms, and regulatory requirements.
• Coordinate with hospitals/service providers, and internal stakeholders for claim resolution.
• Identify discrepancies, red flags, and suspected fraudulent claims, and escalate as required.
• Maintain high accuracy and quality standards in claim assessment and decision-making.
• Support audits, compliance reviews, and management reporting related to claims.
• Drive customer satisfaction through timely claim processing and effective query resolution.

Preferred candidate profile

• Graduation is mandatory
• Must have minimum 2 years of health claims processing experience
• Freshers are not eligible for this role
• Must be okay with work shift on roster basis and flexible week-offs