Insurance Claims Specialist

Job Overview

We are seeking an Insurance Claims Specialist to manage the complete process of cashless insurance claims at our Bengaluru location. This role demands facilitating a hassle-free, clear, and supportive experience for patients during their hospital stay and discharge.

Key Responsibilities

• Manage the entire cashless insurance claim lifecycle, including pre-authorization, approvals, and settlement.
• Liaise with insurance firms and Third Party Administrators (TPAs) for claim submissions, approvals, query resolution, and timely follow-ups.
• Communicate effectively with patients and their attendants by elucidating procedures, required documentation, and the status of their claims.
• Guide patients regarding their insurance policy coverage, including co-payment, deductions, exclusions, and limitations.
• Promptly address and resolve inquiries from insurers or TPAs to prevent delays or denials.
• Monitor claim progress to ensure efficient and timely closure.
• Validate insurance eligibility, policy conditions, and coverage prior to admission or treatment.
• Collaborate with internal departments such as billing, front office, and medical records teams.
• Maintain precise documentation and records of claims.
• Ensure strict adherence to insurance and hospital policies and regulations.
• Support patients during discharge by coordinating necessary approvals and final claim settlements.
• Prepare Management Information System (MIS) reports and assist with audits when required.

Qualifications and Skills

• Graduate degree is preferred; diploma or certification in Medical Billing, Healthcare Management, or Insurance is beneficial.
• Minimum 1 to 3 years of experience managing cashless health insurance claims.
• Strong familiarity with insurance claim procedures and excellent patient counseling capabilities.
• Proficient communication skills, both oral and written.
• Ability to manage multiple tasks simultaneously under pressure with keen attention to detail and documentation accuracy.

Professional Conduct

• Maintain a polished, neat, and professional appearance consistent with formal dress codes.
• Exemplify professional manners, empathy, and courtesy in all interactions with patients and insurance representatives.