Executive - Claims

Job Tile

Executive

List of Responsibilities

• Team Handling: FLP, Billing, Combined, FA, DMS
• Specific Geography Responsibility for Coordination and Claims Processing/ Marketing Escalations/ Claims Escalations from All Verticals / IT Co ordination
• DAC/Audit: Response /Rectification /Counselling along with OH
• Payment query Pending
• TAT Monitoring
• Reimbursement Claims Processing
• Tabulation / Arithmetic Calculations checks as per the agreed Terms/Policy Terms of Reimbursement File
• Coordination with Medical Processors
• Referring back for insufficient documents /Rejection
• Cashless Claim Processing
• Tabulation / Arithmetic Calculations checks as per the agreed Terms/Policy Terms
• Coordination with Medical Processors

Job Description:

• Communicating with insurance agents and beneficiaries.
• Preparing claim forms and related documentation.
• Reviewing claim submissions and verifying the information.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claim payments.
• Performing other clerical tasks, as required.

Job Qualifications and Requirements

• Any Degree
• At least 2 years of experience as a claims processor or in a related role.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to detail.