Claims Executive

We’re Hiring: Claims Executive – Health Insurance Sector Location: Pune Education: Any Graduate Experience: Minimum 1–3 Years in Health Insurance Claims Industry: Health Insurance | TPA | Healthcare Services Are you passionate about making healthcare claims fair, accurate, and efficient? Do you thrive in a fast-paced environment where coordination, attention to detail, and policy knowledge are key? Join our growing team as a Claims Executive and be a vital part of our mission to bring transparency and accountability to the health insurance process. Key Responsibilities: End-to-end handling of health insurance claims — both cashless and reimbursement — in line with insurer/TPA guidelines and policy terms Examine and verify all medical documents , including prescriptions, invoices, discharge summaries, investigation reports, and operative notes Maintain updated data for each case on internal claim processing systems, ensuring no lapse in documentation or tracking Proactively follow up with internal departments, patients, insured members, treating hospitals, TPAs, and insurance companies for missing information, clarification, or approvals Ensure timely submission and response to queries raised by TPAs/insurers during the adjudication process Handle rejected claims with thorough documentation and initiate reconsideration appeals as appropriate Decode insurance policies to identify applicable benefits, sub-limits, exclusions, and waiting periods Understand and apply medical terminology , billing practices, and coding systems (ICD/CPT) to evaluate claims effectively Track and monitor claims from registration to settlement , flagging delays or discrepancies proactively Ensure strict compliance with IRDAI regulations, insurer circulars, internal SOPs, and TPA operational protocols Support senior team members in audits, claim reviews, and internal assessments Identify fraudulent claims, medical mismatches, or billing anomalies and escalate them appropriately Build strong working relationships with hospitals, doctors, and claims handlers to resolve issues smoothly and professionally ✅ Requirements: Education: Any Graduate Experience: Minimum 1–3 years in health insurance claims processing (Cashless or Reimbursement) Prior experience with TPAs, insurance companies, or hospital billing departments is essential Hands-on knowledge of insurance software platforms such as Mediware, iMediNet, HealthConnect, etc. Excellent communication, documentation, and coordination skills Strong understanding of policy structures, exclusions, and medical billing practices Ability to work under pressure, manage multiple cases, and meet TAT and audit requirements Preferred Skills (Not Mandatory): Certification in medical coding or insurance Familiarity with claim audit and fraud detection practices Knowledge of common healthcare procedures, diagnostics, and hospitalization workflows How to Apply: Send your CV to info@healthbridgeindia.in or apply directly via LinkedIn. Join us in making the claims journey transparent, timely, and trust-driven for every insured patient.

Location: pune, IN

Posted Date: 6/18/2025