Assistant Manager - Claims

Job Tile

Assistant Manager

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 4 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.