Claims Processor / Claims Adjudicator

We're Hiring: Claim Processor / Adjudicator – Case Review (Medical & Technical) Location: Pune | Mode: Hybrid Experience: Minimum 2 Years Industry: Health Insurance Claims Are you a BAMS / BHMS graduate with hands-on experience in health insurance claims processing ? Do you have a knack for evaluating medical records, identifying discrepancies, and ensuring claim accuracy? If yes, we want to hear from you! Role Overview: We’re expanding our Health Claim Operations Team at Healthbridge India Pvt. Ltd. , and looking for medical claim professionals who can assess both technical and medical aspects of claims. This role involves adjudication, data interpretation, and fraud detection—ideal for those who thrive on detailed case evaluation and interdepartmental coordination . Key Responsibilities: Review and adjudicate cashless and reimbursement health claims . Assess claims in accordance with policy terms and insurance guidelines . Evaluate discharge summaries, clinical notes, patient history , and medical bills. Identify discrepancies , errors, or potential fraudulent claims . Provide case-based technical and medical remarks to the data analytics team . Collaborate with IT, TPA, hospital, and internal teams to streamline processing. Ensure robust documentation and audit-readiness of each case. ✅ Candidate Requirements: Qualification : BAMS / BHMS (mandatory) Experience : 2 years in health claim adjudication or medical case review Strong command over medical terminology, coding, and procedures Familiarity with insurance protocols, claim workflows , and regulatory compliance Proven experience in fraud detection and investigative case handling Excellent analytical and communication skills Comfort working in tech-enabled environments What We Offer: Competitive salary aligned with industry standards Performance-based bonuses Corporate health insurance (self & family) Career growth in a dynamic HealthTech ecosystem Exposure to cutting-edge insurance claim automation and tools About Healthbridge India Pvt. Ltd.: We are a fast-growing HealthTech company transforming healthcare claims with innovation, accuracy, and speed . With a network of 700 hospital partners , our mission is to simplify and optimize every stage of health insurance claims. Apply Now: Send your CV to info@healthbridgeindia.com or apply directly via LinkedIn. Know someone perfect for this role? Tag them or share this opportunity!

Location: pune, IN

Posted Date: 6/18/2025