Claim representative

About the role

The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.

What you'll do

• Processes claims from members and providers
• Assists queries from providers and payers via phone calls or e-mails
• Maintains files for authorizations and other reports
• Assesses and processes claims in line with the policy coverage and medical necessity
• Be fully versed with medical insurance policies for various groups / beneficiaries

What you need

• 1–2 yrs of experience
• Claims processing
• Reconciliation
• Insurance
• Compliance
• Audit
• SOP writing
• B.Com