Creative Clap - Associate - Health Claims Process

Associate - Health Claims Process (Qualified Doctors)

Job Title: Associate - Health Claims Department: Health Claims

Location: Bangalore Reporting To: Associate Manager- Health Claims

Desirable Skills and Abilities:

- Ability to handle independent assignments & having the acumen to take logical conclusions

- He/she should have a broad understanding of Claims Practice.

- Sharp business acumen to understand health insurance claim servicing needs

- Excellent communication skills, including writing reports and presentations

- Ability to anticipate potential problems and take appropriate corrective action

- Knowledge of health regulations, IRDAI circulars is must

Desirable educational qualification & experience:

- Medical Graduate in any stream

- Experience of working on Excel, powerpoint presentation is must

- Candidates having data analytics experience would be an added advantage

Role Responsibilities:

- Adjudication of health insurance claims for Cashless and Reimbursement claim type

- Negotiate with the treating doctor/ hospital in reducing the un-justified hospitalization cost

- Automate system and bring in improvements on claims processes

- Monitoring systems and processes to ensure sustained levels of performance

- Liaison with internal stakeholder to ensure the deadline of TAT's and SLA's & Work towards Designated

Tasks

- Tracking of customer communication for effective grievance resolution within TAT & SLA's

- Compliance- Through knowledge of products, regulations, guidelines is must to ensure process compliance all the time.

- Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics.

- Team Management- Build and manage the team of processing doctors supporting the function