Health Claim Processing Executive
PPM BUSINESS MANAGEMENT PVT LTD
Claim Processing Officer
Key Job Requirements
Education
Graduate
Experience Needed
Experience (2 Yrs, 0 Mths)
Gender
Both
English Requirement
Good
Days Of Work
10:00 Am - 7:00 PM
Work Hours
Monday - Saturday
About the Health Claim Processing Executive Job
Job Title: Claim Processing Officer
Salary:₹25,000 – ₹35,000 per month
Experience: 2–5 Years
Job Type: Full-Time
Job Summary
We are looking for a detail-oriented and efficient Claim Processing Officer to manage insurance and healthcare claim processing. The ideal candidate will be responsible for reviewing, verifying, and processing claims accurately while ensuring compliance with company policies, regulatory guidelines, and service-level agreements.
Key Responsibilities
* Review and process insurance or healthcare claims accurately and within defined timelines.
* Verify claim documents, medical records, invoices, and supporting documentation.
* Evaluate claim eligibility in accordance with policy terms and company guidelines.
* Coordinate with hospitals, insurance companies, TPAs, and internal departments to resolve claim-related issues.
* Identify discrepancies, investigate claim exceptions, and recommend appropriate resolutions.
* Maintain accurate claim records and update claim status in the system.
* Prepare daily, weekly, and monthly claim processing reports.
* Ensure compliance with regulatory requirements and organizational policies.
* Respond to claim-related queries from customers and stakeholders in a professional manner.
* Maintain confidentiality of customer and claim-related information.
Required Skills
* Strong knowledge of insurance and healthcare claim processing.
* Familiarity with medical terminology, billing procedures, and insurance documentation.
* Proficiency in MS Excel and claim management software.
* Excellent analytical, problem-solving, and organizational skills.
* Strong attention to detail and accuracy.
* Good communication and interpersonal skills.
Qualifications
* Bachelor's degree in Commerce, Healthcare Administration, Business Administration, or a related field.
* 2–5 years of experience in insurance claims, TPA operations, hospital billing, or healthcare claim processing.
* Knowledge of cashless claims, reimbursement claims, and health insurance policies will be an added advantage.