Job Description:

• Claim Adjudication: Reviewing and processing claims within agreed Turnaround Times (TAT) and service standards to ensure accuracy and policy compliance.
• Documentation Verification: Collecting and verifying necessary documentation (medical records, reports, invoices) to validate claims.
• Customer Communication: Managing inquiries from policyholders, intermediaries, and medical providers regarding claim status.
• Data Management: Accurately inputting claims into the system database to maintain accurate records.
• Liability Determination: Assessing if a claim is covered by the policy, approving or denying coverage, and initiating payment processes.
• Risk Mitigation: Identifying potential fraud and ensuring compliance with regulatory and company procedures. 
   

• Analytical Skills: High attention to detail for reviewing complex policy documents and verifying data.
• Communication Skills: Strong verbal and written communication for handling client queries and negotiating settlements.
• Technical Skills: Proficiency in MS Office and specialized insurance/claims management databases.

Industry:

HealthCare

Category:

Health

Skills: